Qualitative Exploration of Need for Adolescent Sexual and Reproductive Health Care and Service Pathways Readiness During Pandemic in Nepal.

backgroundCOVID-19 pandemic disrupted adolescents' access to sexual and reproductive health (SRH) services for adolescents in Nepal. This study explored adolescents' and health care provider's perspectives on how the COVID-19 pandemic affected adolescents' SRH information and services, SRH-related behaviours, and factors that strengthen care and service pathways during the pandemic in Nepal.

methodsThis study used qualitative methods and adapted the social cognitive theory as an analytical framework to explore individual, social and environmental influences on adolescents' sexual and reproductive health (SRH) information and services pathways during the COVID-19 pandemic. A total of 86 participants were included in the study, including 64 adolescents (15-19 years) and 22 service providers. For this, total of six focus group discussions, 12 in-depth interviews and 22 key informant interviews were conducted. Thematic analysis was conducted to identify, analyse and interpret the data.

resultThe study findings showed that COVID-19 disrupted adolescents' SRH information and services pathways through interconnected environmental, social and individual factors. School closures reduced access to school-based SRH information and opportunities to interact with teachers and peers, while interruptions in service delivery compromised adolescent's pathways to SRH information and services. Adolescents reported changes in sexual behaviours and mental health effects during pandemic. Strengthening adolescents' pathways to SRH information and service during crises requires provider's capacity strengthening, conducting virtual child club programmes for self-help and social interaction, digital information and psychosocial services, and prioritising coordinated interventions among stakeholders.

conclusionMaintaining adolescent SRH care during public health emergencies requires an ecosystem approach addressing individual, social and environmental factors together. Adolescents' SRH needs during public health emergencies extend beyond the availability of clinical services and include opportunities for emotional, social and trusted support. Strengthening adolescents' self-efficacy, conducive social environments, and community-based actors such as Female Community Health Volunteers (FCHVs) along with accessible, confidential and adolescent-responsive services, helps maintain continuity of sexual and reproductive health and rights (SRHR) information and care during emergencies. PATIENT OR PUBLIC CONTRIBUTION: This manuscript is developed from the study done under the larger project that was designed to address sexual and reproductive health and rights (SRHR) of adolescents and women in the Sindhupalchowk district. The study adopted a participatory approach through active engagement with adolescents, community actors, health service providers, and local stakeholders throughout the research process. Different consultation meetings were held with these stakeholders to identify research priorities, refining research questions and development of study tools to ensure contextual relevance and responsiveness to community SRHR needs. The findings further emphasise the importance of community-based SRHR approaches, strengthening local actors and volunteers and fostering adolescent self-efficacy in supporting adolescent responsive services during public health emergencies.