Sexual and reproductive health access and service delivery among adolescents and youth in Mogadishu, Somalia: findings from a mixed methods study

Background Access to basic sexual and reproductive health (SRH) is a challenge for adolescents and youths (AYs) in Somalia, a country that has endured decades of conflict. There is limited information on how (if at all) SRH services are tailored for AYs, and whether and how this age group access SRH services. We sought to assess access and delivery of SRH services for AYs in four districts of Mogadishu. Methods We conducted a mapping of SRH service providers, semi-structured interviews with SRH service providers (n = 8) and focus group discussions stratified by gender, age and marital status (n = 59). The qualitative data were thematically analysed, whereas quantitative data were analysed using descriptive statistics. Results We identified 21 health facilities offering SRH services; however, we found that these services were not tailored to the needs of AYs. Some of the significant barriers to SRH service access observed are stigma and social norms (especially for unmarried females), patriarchal decision-making structures requiring male consent (fathers, uncles, husbands) to access SRH, delays in help-seeking among AYs, and financial, logistical and systemic constraints that make SRH access a challenge for this age group. Conclusions This study underscores the need for greater investment in adolescent-friendly SRH services in Somalia. This includes social and gender norm change activities (including engaging religious leaders) to improve AY access to SRH. There is a clear need to address the barrier of male consent for women to access SRH.