This study aimed to determine disparities in sexual and reproductive health service utilization and associated factors among agrarian and pastoralist adolescents in the South Omo zone of Southern Ethiopia. The findings revealed that overall sexual and reproductive health service utilization was 27.4% (95%CI: 26.9, 27.8). This finding was higher than studies conducted in Gamo Gofa (16.9%)15 Philippines (13.8%)16, Indonesia (24.3%)17 East Gojam, Ethiopia (21.5%)18 and Ethiopia 19.18%)19. However, lower than the study conducted in Jima Ethiopia, 41.1%20; Eastern Ethiopia, 39.3%21; Wolaita, Southern Ethiopia (49.8%) 22 and Kenya 36%) 23. This disparity may be explained by time differences, study populations, and settings.
There was a significant difference in SRH service uptake between adolescents in agrarian (36%) (95%CI: 35.5, 36.4) and pastoralist (18.7%) (95%CI: 18.3, 19.0). This difference may be due to the distance from health institutions and cultural influences in pastoralist communities (Karamoja, Uganda24 and may be higher than that in the study conducted in Southern Ethiopia25. This study revealed that pastoralist ASRH service utilization was lower than in studies conducted in Northern Ethiopia (24.9%)26. This difference may be due to cultural and study setting differences.
This study revealed that condom use in recent sexual intercourse was 6.3% (95%CI: 6, 6.5), which is lower than studies conducted in Gurage, Ethiopia (13%) and Debre Berhan, Ethiopia (26%)14, 27. Sexual and reproductive health information and education was 26.4% (95%CI: 25.9, 26.8). This finding was higher than study conducted in Debre Berhan, Ethiopia 23.7%27. But lower than that study conducted in Haramaya District, Ethiopia 29.5%28. Adolescents used any modern contraceptives was 10.5% (95%CI: 10.1, 10.8). This finding was lower than study conducted in United States (24%)29 and similar to study in Gurage, Ethiopia 10.8%14. Adolescents diagnosed and treated for STI during the last 12 months was only 1.8% (95%CI: 1.6, 1.9). This finding was lower than studies conducted in West Badwacho, southern Ethiopia 23.4%11, United States (22%)29.
Adolescents discussed SRH services with their parents were 16.8% (21.1% agrarian and 12.6% pastoralists) (95% CI: 16.4, 17.2). This finding was lower than studies conducted East Gojam 32%, Debre Brebrehan town 36.4%), and Asgede Tsimbla 51.7%18, 27, 30. Discussions of SRH services with their friends was 23.3%. This finding was lower than study conducted in Goba Town, Ethiopia 73%31.
adolescents heard about SRH was 59% (64.4% agrarian and 51.6% pastoralists) (95% CI: 58.5, 59.5).This finding was higher than studies conducted in Gurage 56.7% and East Gojam 38.3%14,18. Adolescents with good knowledge were 37.1% (95% CI: 36.6, 37.6). This finding was higher than study conducted in Uganda 33.7%), Malaysia 10.8%), and lower than studies conducted in Gurage 47.2%) and East Gojam 67%32, 33, 14, 18.
According to the results, uneducated adolescents were less likely to utilize SRH services than adolescents educated by both agrarians and pastoralists. Research in Nigeria and Ethiopia supports this finding34,35. Adolescents who had to travel for less than 30 min to obtain a health facility were more likely to use SRH services than those who had to travel for more than 30 min in both agrarian and pastoralist areas. This is supported by studies conducted in Kathmandu, Nepal, Philippines, Awabal, and Ethiopia16, 36,37.
Adolescents who discussed SRH services with their parents were more likely to use SRH services as compared to adolescents not discussed with their parents in pastoralist adolescents. This finding is supported by studies in Ethiopia 30, 36,38,39. Adolescents encouraged by their fathers or mothers were more likely to use SRH services than those who were not. This finding was supported by studies conducted in Martapura Health Center, Indonesia, which indicated that family support is vital for adolescents to use reproductive health services 40.