The world population is made up of slightly one quarter of young people (10-24 years) . In developing countries, this group constitutes 32 per cent of the population  and are faced with several neglected health problems including sexual and reproductive health problems. In Nigeria, about 26.1% of the population are within 12-24years . Nineteen per cent of the adolescents (15-19) had begun childbearing  and are more likely to experience adverse pregnancy outcome than those who delayed childbearing. Moreover, the incidence and prevalence of sexually transmitted infections are high among young people aged 15-24 years [4,5]. In 2018, 510,000 young people between the ages of 10 and 24 were newly infected with HIV, of whom 190,000 were adolescents between the ages of 10 and 19 years . Adolescents are also at risk of other SRH problems such as unsafe abortion, early marriage, and sexual violence. Adolescents are exposed to these problems mainly due to their unhealthy sexual behaviours such as early sexual debut, multiple sexual partners, and unsafe sex . Access to and utilization of Sexual and Reproductive Health Services (SRHS) are essential for the prevention of sexual and reproductive health (SRH) problems and diseases.
Though, availability and accessibility of SRHS are still poor in developing countries [8, 9] including Nigeria, the little services that are available and accessible are underutilized by adolescents [10, 11]. Yet, there are increase in the incidence and prevalence of SRH problems and diseases among adolescents such as teenage pregnancy, unsafe abortion, sexually transmitted infections (STI), HIV and AIDS in sub-Saharan Africa . Adolescents are supposed to make effective use of these services because these services are meant to promote the sexual and reproductive health of every individual. Utilization of health services is measured based on health outcomes and percentage of persons that use the services . The significant impact of SRHS’ utilization can be observed in reproductive health outcomes such as pregnancy and birth, prenatal and neonatal mortality, maternal mortality, Sexually Transmitted Infections (STIs) and HIV and AIDS, and complications of abortion . The World Health Organization stated that nearly 20 per cent of all global maternal deaths happen in Nigeria  with the risk higher among adolescent girls , suggesting that adolescents’ utilization of sexual and reproductive health services is low.
Many factors could determine adolescents’ utilization of SRHS in Nigeria, despite efforts to make SRHS available at the primary healthcare facilities. These factors which are referred to as predictors in this study range from social, personal, psychological and health system factors. The level of secrecy accorded to sexuality in Nigeria with its direct and indirect implications, makes it difficult for sexually active adolescents to freely access and use SRHS, exposing a high percent of them to STIs . It is, therefore, important to study the perceived predictors carefully to inform health professionals and policy makers, which would enable them to understand the SRH challenges the young ones are facing and explore possible ways of addressing them. For this study, predictors were studied under the following subcategories: socio-demographic, psycho-cultural, and health system factors, to find out if they predicted adolescents’ utilization of SRHS. Socio-demographic factors include age, gender, level of education, religious affiliation, location, living status, marital status, economic status. Research has linked sociodemographic factors and adolescents’ utilization of health services [18, 19].
Moreover, one’s cultural and personal belief may influence the individual’s perception of accessing and using health services. Psycho-cultural refers to the interaction of psychological and cultural factors in the individual’s personality or in the characteristics of a group . Psycho-cultural factors in this study refers to those cultural beliefs or values that affect the psychology of the youth in seeking for or using SRHS in Enugu State. Psycho-cultural factors included: belief that discussing sexual issues is a taboo, fear of stigmatization or embarrassment based on cultural beliefs, fear of meeting their parents or people they know in the clinics, fear of being labeled a prostitute by community members, fear of not getting married later in life, fear of being barren, and other cultural beliefs regarding the use of SRHS by youths. For example, in some societies, most people assume that providing SRHS for the youth, like provision of sexuality education and contraceptives, promote promiscuity. These fears and burdens are capable of limiting adolescent’s use of SRHS and could result in stigmatizing youths that are bold enough to access and use available SRHS .
Furthermore, health system factors such as availability of quality reliable services, proximity of the facility to users, cost of services, lack of privacy and confidentiality, long waiting time, using services with adults, and the attitude of service providers were assessed as predictors of adolescents’ utilization of SRHS. The nearer the facility to the users, the higher their level of access and utilization. Geographical access, therefore, influences service utilization [22, 9] The main objective of the present study was to determine if these factors predict the adolescents’ utilization of SRHS in Enugu State. This has become necessary because such prediction studies are lacking in the State, while there are observed low utilization of health services among adolescents in Nigeria. We used adolescents and young ones interchangeably in this study.