Socio-ecological influences on sexual and reproductive health service use: Young adults and provider perspectives from Soshanguve, South Africa

Abstract

BACKGROUND: Despite widespread availability of sexual and reproductive health (SRH) services and educational initiatives in South Africa, risky sexual behaviours, including unprotected sex, remain prevalent among young adults. These behaviours drive high rates of unplanned pregnancies, unsafe abortions and sexually transmitted infections. The misalignment between interventions and behavioural outcomes reflects deeper, underexplored systemic barriers - including misinformation, stigma, provider bias and weak policy implementation - embedded within institutional structures and practices. AIM: Guided by the socio-ecological model, this study explored the factors influencing young adults' access to SRH services, drawing on the perspectives of both young adults and SRH providers. SETTING: Three public clinics in Soshanguve township, South Africa. METHODS: A qualitative exploratory study design was used. Semi-structured interviews were conducted with a convenience sample of 15 young adults and a purposive sample of five SRH service providers. Data were analysed thematically. RESULTS: Findings revealed multilevel barriers influencing the use of SRH services by young adults: limited SRH knowledge and misconceptions (individual level); poor parent-child communication and peer pressure (interpersonal level); stigma and religious norms (community level); long waiting times, privacy concerns and provider bias (institutional level) and inadequate youth-friendly policies and restricted access to services like abortion (policy level). CONCLUSION: Improving SRH service access and outcomes requires context specific, multilevel interventions aligned to the perspectives of young adults and providers.Contribution: This study offers a nuanced exploration of SRH service utilisation in an under-resourced setting, generating context-specific insights to inform youth-centred, socio-culturally responsive policy development and service planning.