Submission ID 130760
| Issue/Objective | Adolescents constitute nearly one-quarter of Pakistan's population and undergo critical developmental transitions that shape their sexual and reproductive health (SRH) knowledge, behaviors, and service needs. In rural Sindh, inadequate access to comprehensive SRH education and adolescent-responsive health services, alongside entrenched gender norms and sociocultural stigma, substantially limit adolescents' SRH literacy, autonomy, and service utilization. Current studies capture adolescents lived experiences and perspectives regarding SRH knowledge and access to services across key domains, which remains limited in this setting. |
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| Methodology/Approach | An exploratory, descriptive study was conducted in the rural Matiari district (Saidabad and Hala), Sindh. A total of 12 focus group discussions (FGDs) were conducted with adolescents aged 12-22 years (8 with girls and 4 with boys), each including 7-8 participants. Data were collected using semi-structured guides in Urdu and Sindhi, exploring knowledge and lived experiences across key SRH areas, including puberty and menstruation, early marriage and teenage pregnancy, family planning, maternal health, abortion, gender-based violence, HIV and other infections, LGBTQIA+ needs, men's SRH, and women's empowerment. Discussions were audio-recorded, transcribed, translated into English, and thematically analyzed using inductive and deductive coding in NVivo. Ethical approval and informed consent/assent procedures were obtained. |
| Results | A total of 87 adolescents participated in the study; most participants were aged 15-19 years (56.7%), followed by 12-14 years (38.8%). The mean age was 15years. Participants represented a range of educational levels, and the majority were unmarried (74.7%). Across SRH domains (puberty, menstruation, relationships, contraception, early marriage, and gender-based violence), findings revealed a continuum of interrelated barriers affecting knowledge, education, and service access. First, inadequate SRH education and information systems led to fragmented school-based teaching and reliance on peers, resulting in widespread misinformation on menstruation, conception, HIV, and contraception. Second, sociocultural norms and gendered expectations reinforced early marriage, restricted girls' mobility after menarche, and constrained open discussion of SRH issues. Third, these norms and knowledge gaps contributed to limited SRH education in schools, resulting in poor relational and reproductive health literacy among adolescents. Fourth, structural and economic barriers restricted access to SRH services and resources, including limited adolescent-friendly services, financial constraints, inadequate menstrual hygiene facilities, poor school sanitation, and a lack of counseling support. Finally, gender-based violence and weak protection systems normalized abuse within households and limited formal help-seeking, further undermining adolescents' agency across SRH domains. |
| Discussion/Conclusion | Adolescents in rural Sindh face significant gaps in SRH knowledge and limited access to adolescent-friendly education and services, driven by sociocultural norms, weak information systems, and structural barriers. Addressing these challenges requires comprehensive, gender-responsive SRH education and accessible, confidential services to improve informed decision-making and health outcomes. |
| Presenters and Affiliations | Salima Meherali University of Alberta Zahid Ali Memon Aga Khan University Zohra Lassi Adelaide University Hina Najmi Aga Khan University |
