Published in PLOS One on 2026-10-01, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Noah Nyende, Justine Nanteza, Frank Kiyingi, Miph Musoke
Source: PLOS One • DOI 10.1371/journal.pone.0358996
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Adolescents in low- and middle-income countries face high rates of unintended pregnancy, sexually transmitted infections (STIs), and unmet sexual and reproductive health (SRH) needs. In Uganda, 24% of girls aged 15–19 years have begun childbearing, yet modern contraceptive prevalence among adolescents remains low (15%). These challenges are particularly severe in the Busoga region, where sociocultural norms, poverty, and limited health system capacity hinder access to adolescent-friendly SRH services. Despite national guidelines, utilization remains low. Few studies have triangulated perspectives from adolescents, health providers, and community/religious leaders. We explored stakeholder views to provide an integrated understanding of factors influencing adolescent SRH service utilization in Busoga, Uganda.
An exploratory qualitative study was conducted in Iganga and Bugweri districts. Four focus group discussions with 38 adolescents (13–19 years), stratified by sex, age group, and residence, and 12 key informant interviews with health providers and community leaders were conducted. Adolescents were recruited through peer networks, while key informants were purposively selected. Data were collected (November–December 2024), transcribed verbatim, and analyzed inductively using thematic analysis with NVivo 14. Ethical approval and informed consent/assent were obtained.
Adolescents, health providers, and community stakeholders described SRH service utilization as shaped by adolescent motivation alongside persistent barriers. Adolescents showed strong preventive intent, but uptake was limited by misconceptions about contraception, fears of infertility, long distances, lack of privacy, negative provider attitudes, and commodity stock-outs. Providers and community leaders echoed concerns around misinformation, limited parental guidance, moral norms, and structural constraints. All stakeholders converged on the need for confidential, accessible, and peer- and community-based adolescent SRH services.
Adolescents in Busoga are motivated to use SRH services, but intersecting sociostructural and system barriers limit utilization. Strengthening adolescent-friendly services, improving provider responsiveness, addressing misinformation, and expanding community-based delivery are essential to enhance equitable access.
Introduction
Adolescence is a critical developmental stage marked by rapid physical, psychological, and social transitions that have lasting implications for sexual and reproductive health (SRH) outcomes [1,2]. Globally, adolescents account for a disproportionate burden of unintended pregnancies, unsafe abortions, and sexually transmitted infections (STIs), particularly in low- and middle-income countries [2]. In sub-Saharan Africa (SSA), recent evidence continues to highlight persistent structural, sociocultural, and health system barriers that drive low utilization of SRH services and sustain high rates of teenage pregnancy and HIV [3,4]. Kenyan and Ethiopian studies, for example, identify transport costs, judgmental provider attitudes, restrictive cultural and gender norms, fear of stigma, and lack of privacy as recurring obstacles [5,6].
In Uganda, adolescent SRH indicators remain concerning. Early sexual debut, low contraceptive uptake, and high rates of adolescent pregnancy persist [7–9]. Uganda’s adolescent pregnancy rate (teenage childbearing) is approximately 24% among girls aged 15–19 years, HIV prevalence among 15–19-year-olds is 2.1%, and only 15% [10]. The Busoga Region is particularly affected because of poverty, early marriage norms, and limited services [11]. Recent studies in the region confirm high non-utilization of modern contraceptives and SRH services, influenced by lack of confidence in discussing contraception, perceived inaccessibility of services, and limited interaction with community health workers [12].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Noah Nyende, Justine Nanteza, Frank Kiyingi, Miph Musoke. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Preconception care services in Northern Ethiopia: A qualitative exploration of awareness, experiences, challenges, opportunities, and prospects
- Evidence brief: Strengthened HPV vaccination among adolescents living with HIV, – Findings of a Pilot QI project in Kampala Metropolitan, Uganda
- Evidence brief: “Heartbreak and Frustration’’ experiences of healthcare providers caring for pregnant women with sickle cell disease in Uganda
