Barriers to care: female university students’ distrust and fear of accessing sexual and reproductive health services in Zambia

Abstract

BACKGROUND: Sexual and reproductive health (SRH) services are widely available in Lusaka, Zambia but use among adolescent girls and young women remains low. This study investigated the perceptions and experiences of a sub-sample of female university students accessing clinic-based SRH services. METHODS: Thirty-four female students participated in focus group discussions in June-August 2022. Participants were recruited from a survey at a public university, where interested participants could opt-in to join focus groups discussing experiences and perceptions of SRH services. Focus groups were audio recorded, transcribed, and analysed using a line-by-line constant comparison approach in which a codebook based on the research questions was created a priori and revised as new codes inductively emerged. Key themes and illustrative quotes related to experiences and perceptions of SRH health care were identified. RESULTS: The most salient theme was widespread fear of seeking SRH services and interacting with healthcare providers. Three sub-themes included: (1) receiving moral judgement instead of health information; (2) negative clinic experiences; and (3) privacy concerns. As a result, a second theme revealed a reliance on less effective contraceptive methods, describing that these culminating experiences have led to decreased interest for SRH services. CONCLUSION: As one of the few qualitative studies on female university students in a high HIV-prevalence setting, we identified key barriers in the healthcare system that hindered the use of critical SRH services. This research contextualised the use of less effective contraceptive methods, low uptake of pre-exposure prophylaxis, and persistent suboptimal SRH outcomes in this sub-population of young women.