RESUMO
INTRODUCTION: Adolescents face multiple barriers in accessing information and health care services. Rural and urban differences in access to and use of reproductive health services (RHS) exist but the extent is unclear. We identified and compared the factors influencing access to and utilization of RHS among adolescents in urban and rural communities in Rivers State, Nigeria. METHODOLOGY: A comparative cross-sectional study design was used. In sequential explanatory mixed methods. First, a quantitative survey interviewed 507 adolescents, 255 in urban and 252 in rural communities. This was followed by a narrative approach to qualitative inquiry using focused group discussions. Access and utilization were determined, and predictors of access and utilization were derived from multivariate logistic regression models using adjusted odd ratios. RESULTS: The median ages and interquartile ranges were 16.0 (14-19) and 14.0 (12-16) years for urban and rural respondents respectively. Utilization of RHS was low, 65 (25.5%) in urban, 57 (22.6%) in rural. Access to services was also low, 81 (31.76%) urban versus 8 (3.17%) rural have economic access to RHS. Age, level of education, awareness of RHS, and sexual experience were predictors of access and utilization in both communities, beliefs that condoms can prevent STIs/ HIV, and exposure to mass and socio-media influenced access and utilization of RHS. Specifically, the age group (15-19 years) of respondents was found to be a significant predictor of utilization of RHS for both urban (cOR=4.32, 95% CI; 0.82-22.69, p=0.001) and rural (aOR=7.65, 95% CI; 1.99-29.40, p=0.003) adolescents. The barriers to the utilization of RHS were ignorance, lack of awareness, parental influence, and financial constraints. CONCLUSION: Adolescents in urban areas have more access (3 in 10) and utilization of RHS compared with their rural (3 in 100) counterparts. There is a need to promote information and education on RHS among adolescents, especially in rural areas.
