Health Providers' Response to Female Adolescent Survivors of Sexual and Gender-Based Violence and Demand Side Barriers in the Utilization of Support Services in Urban Low-Income Communities of Nigeria.

Survivors of sexual and gender-based violence (SGBV) are often hindered in their quest to access quality healthcare. This has a significant effect towards the achievement of Sustainable Development Goal SDG Target 3.7. to ensure universal access to sexual and reproductive healthcare services. This study is focused on identifying some of the demand side barriers in accessing health care services, particularly among young girls who are survivors of SGBV within intimate relationships in poor urban areas in Nigeria. The study used an ethnographic approach to solicit information from health providers, adolescents, and young women (AYW) in 10 low-income communities in two major cities in Nigeria, Ibadan and Lagos. Findings showed that there are structural limitations within the primary health care (PHC) system that posed a great challenge for survivors of SGBV to access services. Some of these include non-existing counseling services, a lack of rehabilitation centers, poor referral, and a lack of training for health providers in handling survivors of SGBV. There is also a lack of skills among health service providers that have negative influence on support services to survivors of SGBV. On the demand side, poor knowledge of possible health seeking pathways, a lack of education, and social support are barriers to accessing appropriate services among adolescent and young SGBV survivors. The study concluded that integrated services at the PHC level should include adequate and timely treatment for survivors of SGBV and targeted intervention to upscale skills and knowledge of health care providers.

Socioeconomic inequalities and family planning utilization among female adolescents in urban slums in Nigeria.

Background/statement of problem: Family planning (FP) utilization is important for preventing unwanted pregnancy and achieving optimal reproductive health. However, the modern contraceptive prevalence rate (mCPR) among women of childbearing age is still low in many low- and middle-income countries (LMIC), particularly in Nigeria, despite interventions to increase access and utilization. The low mCPR has been associated with a high prevalence of unwanted pregnancy, unsafe abortion, sexually transmitted infections such as HIV/AIDS, and high maternal and infant mortality in LMIC. Despite existing studies associating high family planning utilization to urban settings relative to the rural areas, the socioeconomic inequality in urban settings, especially among adolescents in urban slums has been given less research attention. This study examines the role of socioeconomic inequality on family planning utilization among female adolescents of various ethnic backgrounds in urban slums in Nigeria. Methods: The study utilized data from the Adolescent Childbearing Survey (2019). A total sample of 2,035 female adolescents of ages 14-19 years who were not pregnant at the time of the study and were resident in selected slums. Associations between socioeconomic inequalities-measured by wealth index, social status, and education-and modern contraceptive use were examined using relative and slope inequality indices, and logistic regression models. Results: The results show that only 15% of the female adolescents in the North, and 19% in the South reported modern contraceptive use. While wealth index and education were important predictors of FP use among adolescents in southern urban slums, only education was important in the North. However, the relative and slope inequality indices further indicate that adolescents with no education and those in the lowest social status group use much fewer contraceptives compared to their counterparts with higher wealth and social statuses. Those with secondary/higher education and the highest social status group, respectively, were more disadvantaged in terms of FP utilization (Education: RII = 1.86, p < 0.05; 95% C.I. = 1.02-2.71; Social Status: RII = 1.97, p < 0.05; 95% C.I. = 1.26-2.68) with results showing a more marked level of disparity when disaggregated by North and South. Conclusion: The persistent socioeconomic inequalities among female adolescents in Nigeria, especially those in the urban slums, have continued to limit their utilization. Policy measure in education, communication and subsidized contraceptives should be intensified for vulnerable female adolescents in the slums.

Exposure to job-related violence among young female sex workers in urban slums of Southwest Nigeria.

BACKGROUND: In Nigeria, many young girls are engaged in commercial sex work as a means of livelihood and support of dependent relatives. Although studies have documented some of the violence related issues among commercial sex workers, the plight of adolescent and young sex workers particularly in urban slums may be different in context and depth. OBJECTIVE: This study explored the lived experiences of violence and health related harm among vulnerable young female sex workers in urban slums in Ibadan and Lagos, Southwest Nigeria. It also analyzed their coping strategies and survival mechanisms. DESIGN: The study is cross-sectional and applied an interpretive phenomenological approach to this qualitative study through in-depth interviews. PARTICIPANTS: Young female sex workers ages (15-24 years) who reported having experienced violence were recruited for the study. Twelve participants completed the interviews out the 20 initially contacted. DATA COLLECTION AND ANALYSIS: Primary data were collected using in-depth interviews (IDIs). Data were transcribed using a phenomenological framework analysis. Participants' reports based on life experiences were identified: lived experience "daily brothel life experience"; sources of violence such as law enforcement agents' intermittent raids; violence experience with clients who often demanded sexual acts beyond the agreed scope; and coping strategies employed to mitigate the challenges. SETTINGS: The study was conducted in brothels of two selected slum areas in Ibadan and Lagos, Southwest Nigeria. RESULTS: The results showed that the major motivation for engaging in commercial sex work was for economic reasons. However, there are inherent risks involved particularly for the vulnerable young people. Stigmatization from the community, clients' uncontrolled-aggressive behavior and harassment from law enforcement agents are some of the frequent violence experiences reported. Self-help coping strategies are usually employed to prevent or mitigate the challenges. CONCLUSION: The plight of this young people required policy and program attention towards alternative economic empowerment to rehabilitate those willing to leave the profession. Also the need to develop arm reduction interventions towards protection of young sex workers against violence.

Women Deprivation Index and Family Planning Utilisation in Urban Geography of West African Countries.

Inequalities in health care utilisation and outcomes vary significantly across geographies. Though available evidence suggests disparity in contraceptive uptake in favour of urban compared with rural geographies, there are unassessed nuances among women in urban communities. This study examines some of these disparities within the context of socioeconomic deprivations and family planning utilisation among urban women in West Africa. A secondary analysis of the most recent Demographic and Health Survey dataset of five selected West African countries was conducted, using pooled data of 21,641 women aged 15-49 years. Associations between family planning utilisation and women's deprivation status were investigated using a binary logistic regression model. The findings show that more than one-quarter of the women were severely deprived across the countries except Senegal (17.4%), and the severely deprived consistently have relatively low contraceptive prevalence rates (CPR) (16.0-24.3%) compared with women with no/low deprivation across the countries except Senegal (39.8%). The results for long-acting reversible contraceptives (LARC) were not consistent across the five countries: whereas, LARC utilisation was lower among severely deprived women in Nigeria (9.1%), Guinea (9.6%), and Mali (19.3%), utilisation was similar across the deprivation groups in Benin and Senegal. In the multivariable analyses, the log-odds of modern contraceptive utilisation decreases by 0.27 among the moderately deprived (ß = -0.27, SE = 0.05, p < 0.01) and by 0.75 among the severely deprived women (ß = -0.75, SE = 0.05, p < 0.01) compared with those with no/low deprivation, with variations across the countries. Similarly, the log-odds of LARC utilisation decreases by 0.44-0.72 among the severely deprived women compared with those with no/low deprivation across the countries except Senegal. This study concluded that family planning intervention programmes and policies need to underscore the deprivation context of urban geographies, particularly among women living in informal settlements.