In sub-Saharan Africa, there are several unmet needs regarding sexual and reproductive health of populations. Youths are particularly at risk of facing the results of these gaps. While exploring the access that the youths in Bamenda have regarding the abovementioned services, we notice that most services are made available to them. Youths in Bamenda are exposed to HIV-related services, including testing, counselling, and anti-retroviral therapy; there are equally available contraceptive products; sexually transmitted diseases prevention and treatment; menstrual hygiene tools; and protection from gender-based violence. These services are provided by multiple actors from diverse backgrounds. The state runs health facilities which offer a range of services from primary healthcare to tertiary healthcare, meanwhile some of the health facilities in the region are privately-owned. These facilities offer a range of sexual and reproductive health services. On the other hand, non-governmental organizations in the region support the provision of SRH services with a focus on creating awareness through workshops and other methods. Moreover, according to participants, most instances of gender-based violence are particularly addressed by these organizations in the region. Although it could be established that youths in Bamenda generally have the possibility to access SRH services, several nuances could be evoked as to the real accessibility of these services.
First, the context of Bamenda and the Northwest region of Cameroon. There has been an ongoing crisis in the Northwest and Southwest regions since 2017 [3, 5]. This socio-political crisis has led to the destruction or closure of several health facilities, pharmacies, and retail stores for contraceptive products in Bamenda. Furthermore, there are weekly lockdowns in the town with people prevented from free movements except for essential services. This state of conflict has weakened the heath system in the region and to some extent limits access to primary SRH services. Youths may not be able to get contraceptives or even menstrual hygiene tools at will. The effect of this crisis may go beyond limiting access to healthcare but also have several secondary effects namely, unwanted pregnancies, abortions, drop-outs from schools etc. This certainly impacts families and society at large. We can even argue that the absence of some SRH tools can affect the future of youths in Bamenda. Due to the profound and far-reaching consequences of the context of conflict on the sexual and reproductive health of youths, the case of Bamenda needs to be looked at very closely [6–8]. In Juba, South Sudan, Casey et al. describe how war has severely impacted women by significantly increasing the numbers of unwanted pregnancies and abortions [7].
In the literature, stigma has been described as a major barrier for youths to access SRH services [9, 10]. During these focus group discussions, this factor seemed to be a huge concern to the youths in Bamenda. It was mentioned more than once as a hinderance to youths in getting SRH services. The stigma felt by youths usually comes from providers of care and vendors of SRH products like contraceptives. Youths feel that the actions they are taken are judged by healthcare providers. However, to encourage uptake of SRH services, health workers play a key role in health promotion. They would have to respect the decisions of youths and provide them with freedom to make choices. Moreover, these people offering sexual health related services may act as counselors to the youths, who would want someone who can understand them and to whom they can confine to. Conversely, if youths feel stigmatized, they are likely to take decisions by themselves, which may could be detrimental to their health. The creation of ‘youth-friendly centers’ as a solution suggested by the youths in Bamenda should be understood as creating a community that would understand them; one that will be supportive of their sexual and reproductive wellbeing. Also, digital health was strongly highlighted as a solution to the access problem that the youths in Bamenda are facing. It would be interesting to be able to provide them with such services and improve their access to SRH while contending with some barriers like stigma [11].
Regarding finances, it is important to first point out that some services related to the sexual and reproductive health of youths is free of charge in Bamenda as it is all over Cameroon. In the case of HIV-related services, for example all services are free, from health education through testing to dispensation of medications. Also, regarding contraceptives, it is not uncommon to see distribution of condoms within hospital settings and out of hospital settings in Bamenda. Also, health education is mostly free of charge. Although there is some access to these services, not all SRH services can be afforded by youths in Bamenda. Some types of contraceptive methods are beyond the reach of average youths who are students and who are dependent on their parents. In such cases, they may want to have some products, but they are limited by their financial power. Also, the effect of the ongoing crisis in the Northwest region of the country has an indirect effect on finances. Many individuals and households in Bamenda have seen their purchasing power reduce over the past few years. Moreover, the prices of some health products sold by vendors like menstrual hygiene and contraceptive tools may have known an increase as these vendors have become fewer and it has become more constraining to freely sell. Given that out-of-pocket payments is the basic source of financing health services in Cameroon, we can argue that the crisis has limited access to sexual and reproductive health in the region. In Cameroon, since April 2023, the Ministry of Public Health launched the first phase of the Universal Health Coverage. This program intends to significantly ameliorate access to healthcare amongst the most vulnerable by providing health services free of charge. In the future, during subsequent phases of the project, it would be important to consider youths in a conflict affected setting like Bamenda as bring vulnerable and in need of access to basic SRH products, especially during periods of protracted lockdown and insecurity.
The main limitation of our study was the sample and gender imbalance size. Although all participants were community leaders with a certain influence of youths in Bamenda, having a wide range of responses from more youths would have made a stronger sample. In addition, the male gender was underrepresented. Further studies can include a more equitable and a wider audience. Despite these limitations, this research significantly points out the opportunities that can be exploited during conflict, and improve access to sexual and reproductive health. This would be helpful to inform policy in Cameroon and similar regions.