Barriers to Adolescents Accessing Sexual Reproductive Health Care in Grenada

IntroductionIt is estimated that 34% of adolescents in the Caribbean countries reported that they have had sexual intercourse, of which 38% reported that their initial encounter was forced (1). Adolescents initiating sex early between the age ranges of 10-19 years old had an increased amount of risk factors. These early exposures to violence are particularly concerning in the Caribbean context, where it has been documented that most initial intercourse experiences of Caribbean girls were coerced and occurred at a time when they were most vulnerable to be sexually exploited and initiated to intercourse even before they were emotionally ready (1). Risk factors include low socioeconomic factors, poor knowledge of STIs, overall lack of knowledge about sexual health, and disregard for contraceptive methods (2-4).In Grenada, it has been estimated that six out of ten young people aged 15 to 24 reported more than one sexual partner (4). It was also seen that less than half of young people aged 15 to 24 correctly identified ways of preventing sexually transmitted diseases and HIV (5). Among those who report having had sex, two-thirds did not use a condom all the time (2,5). In developing countries such as Grenada, sexual health education is an issue (6,7)With 23% of the population in Grenada being of adolescent age, it is important to educate adolescent students in the school system to reduce the incidence of sexually transmitted infections (STIs), unwanted pregnancies, and increase the use of contraception4. The most effective method of impeding the unwanted outcomes is through the use of primary prevention. Primary and secondary prevention methods aim to prevent these diseases and conditions before they actually occur.Grenada, like other English-Speaking Caribbean countries, adopted the Health and Family Life Education (HFLE), which was created in collaboration of the United Nations Children's Fund (UNICEF) and the University of West Indies (UWI). The program is currently integrated into the primary and secondary school curriculum. HFLE is a mandated program that provides life skills education, which includes ways to deal with bullying, violence, and sexual health problems (7). In addition to HFLE Non-Governmental Organization's (NGO), organizations such as Planned Parenthood offer sexual health education to adolescents (8). Despite the early sexual initiation, youth do not have the adequate knowledge to protect themselves (5). Subsequently, the needs of adolescents, with respect to sexual health knowledge, behaviors, and perceptions should be understood more thoroughly.To examine the choices of adolescents in Grenadian society, a qualitative study was conducted using focus groups. Specifically, this study explored the knowledge, attitude and perceptions of adolescents' sexual reproductive health practices and behaviors. In addition, this study also examined the perceptions of using NGOs, in particular Planned Parenthood, for sexual health education and medical services.MethodsA sample of adolescents between the ages of 16 and 20 years old participated in one of four focus groups. Participants were recruited from a local college that pulls on people from many places throughout the island, which provides a diverse range of students. A total of four groups of six participants were interviewed. The four groups were then broken down. Two groups consisted of all males, and the other two groups consisted of all females.Participants were recruited into the study with the assistance of the guidance counselor at T.A. Marryshow Community College. Before the focus group discussion commenced, participants were given consent forms. The discussion, which then took place with the facilitators and participants, was audio recorded and later transcribed for analysis.Each transcript was assessed for recurring themes. Themes of understanding why adolescents do or do not access or utilize Planned Parenthood services were observed. …