While Uganda was under lockdown, one of the measures observed during the COVID-19 pandemic, there was a need to study the status of Ugandan youth about sexual and reproductive health and rights services. The youth remain underserved by these services despite their demonstrated need. The Government of Uganda has put in place public health emergency directives and partially lifted the travel ban for pregnant women and people living with HIV/AIDS but access to essential SRHR services such as contraceptives and other family planning packages like condoms, access to ARVs and menstrual health materials by young people have not been prioritized during the lockdown . In this study, we found lack of access to information and services of SRHR during this lockdown (Table 2). These finding support the lack of accessing the information and services among youth worldwide which impact on the future life of a country . It was reported that less than 10% of adolescent women accessed health facilities and information about family planning in 70 developing countries despite the momentum in implementing SRH in most countries .
With global health emergencies, there is a total reversal of priorities and, as a result, the availability, accessibility and affordability of SRHR services has become challenging . During the pandemic, lack of resources may reduce access to SRH and increase maternal and childhood mortality rates . The same findings were found in some other countries while studying the attitudes of health professionals to adolescent SRH issues concerning provision of services in Kenya, Zambia , Swaziland , and Uganda  and the study confirmed reported experiences of young people. Particularly in Uganda, two major surveys conducted among university students indicated that young people had limited access to sexual and reproductive health services and HIV/AIDS-related programmes despite their engagement in high-risk sexual behaviours [26–27]. The West Africa’s large, multi-country Ebola Virus Disease (EVD) outbreak of 2014–2016 tells us that there were significant impacts on SRH, particularly in the early stages of that outbreak, largely related to health facility closures . In Sierra Leone alone, one study estimated that they were an additional 3600 maternal deaths, neonatal deaths and stillbirths related to the decrease in health service utilization during the EVD outbreak . Another study from Guinea found a decrease of 51% in Family Planning (FP) visits during the outbreak . There is significant unmet need for information, education, and services for sexual and reproductive health for married and unmarried young people .
Family planning was reported being used during lockdown among which modern methods uptake was 44.2%. A study done by Thongmixay et al. found similar results that preventive measures that youth used were condoms, oral pills and emergency pills . Our findings are similar to a study done in suburban Shanghai, whereby a youth-friendly intervention program providing information, skills, and services to promote safe sex behaviour (contraception and condom use) compared with a control group; both unmarried females and males aged 15–24 years, showed that the intervention group was 14.59 times more likely to use contraceptives at onset of intercourse, if it occurred . Furthermore, direct access to the modern methods of contraception is important for all types of contraception and especially for emergency, since they are most effective within 72 hours after unprotected intercourse – the earlier it is used the more effective the result . Common barriers to full access and utilization of underutilized long-term contraceptives includes: insufficient supply and deficient quality . Our study found that most of participants (87.2%) had educational level of college/University (Table 1) which could explain their high use of modern methods. Similar findings were reported in a previous study that analysed a trend and pattern of modern contraceptive use in Uganda and showed that there was an increased odd of use of modern contraceptives including long term contraceptives among women with primary and post primary education . Comparably, in an Afghanistan Health Survey (AHS) 2012 indicated that female participants with secondary education or above were 1.62 times more likely to use SRHS unlike their counterparts . This was similar to earlier study findings which noted a positive correlation between contraceptive use and level of education .
Having no transport (68.7%) was the commonest limiting factors to access SRHR services and information during the lockdown followed by distance from home and were to get the services (55.2%), cost of services (42.2%) and curfew (39.1%). The high percentage of no transport as the commonest limiting factors to access the SRHR in our study can be explained by the status of lockdown during the study period which was limiting access to private cars and taxis in order to avoid the spread of the COVID-19 in the community as one of the measures implemented by the Ugandan Government. This finding may also imply that the lockdown may have affected more youth from poorer household with no private means of transport. During the lockdown, less economical activities were allowed in the country and to that a curfew was imposed starting from 7 pm to 6am. Having no transport means, a curfew and the cost of services during the study period and as most of our participants use modern methods which require having money to afford SRHR services could predispose participants to having challenges related to SRHR.
In our study, challenges were more prevalent among the co-habiting followed by unemployed (Volunteer or unpaid) than other participants. In Uganda, reproductive health of adolescents is dependent on several complex and often independent factors including social-cultural influences (such as family, peers and communities), and access to health services, education and employment opportunities . Amooti-Kaguna & Nuwah revealed that in many cases, young people do not reveal their reproductive health problems and tend not to use the healthcare services they actually need and it was found that it may be due to inadequate information, limited access to financial resources or negative attitudes of health workers .
Despite positive advances in health services, sexual and reproductive ill-health remains one of the greatest challenges facing young people. Each year, there are over six million unintended pregnancies among adolescents, most of whom do not have access to modern contraceptive methods . In 2008, over 1.2 million unintended pregnancies occurred in Uganda and these accounted more than half of 2.2 million pregnancies in the country . Also, two thirds (64%) of women reported early sexual debut before the age of 18 years .
Studies have shown the importance of SRH services is essential to prevent unwanted pregnancies and unsafe abortion, and to reduce maternal and child mortality as well as positively affecting poverty reduction and women empowerment . Our results show that cohabiting exposes 2.3 times participants to limiting factor and a challenge relating to sexual and reproductive health and rights followed by unemployed (Volunteer or unpaid) was 1.7 times associated with limiting factor and a challenge relating to sexual and reproductive health and rights than other participants. These findings may also imply that cohabiting and being unemployed could predispose the person to have STDs and unwanted pregnancy which were the commonest challenges faced by our participants in our study. Cohabiting and being unemployed predispose to shortage of money and limited means of transport and yet it was shown that limited means of transport, cost of services and curfew were the most limiting factors to SRHR among our participants and these can explain our findings. This finding may also imply an increase in transactional sex among young girls and women as experienced in other pandemics. A factor highlighted as being behind the spike in pregnancy during the Ebola outbreak was extreme poverty, with girls reportedly having sex in exchange for water, food or other forms of financial protection .
Studies have shown the importance of SRH services is essential to prevent unwanted pregnancies and unsafe abortion, and to reduce maternal and child mortality as well as reducing poverty and empowering women .
Our study revealed that among the challenges faced during the lockdown, STIs (40.4%) were the commonest challenges relating to sexual and reproductive health and rights during this lockdown followed by unwanted pregnancy (32.4%) and sexual abuses (32.4%). Each year, there are over six million unintended pregnancies among adolescents, most of whom do not have access to modern contraceptive methods . In 2008, over 1.2 million unintended pregnancies occurred in Uganda and these accounted for more than half of 2.2 million pregnancies in the country . The Uganda and Health Survey of 2016 points to over 25% teenage pregnancies, among sexually active young people by the age of 16 years, and the unmet family planning need in the country stands at 28% . The reported lack of means of transport as limiting factors to access the services could explain the challenges faced by the Uganda youths during lockdown and to that challenges were more prevalent among cohabited participants and unemployed (Volunteer or unpaid) participants. The lack of accessing STIs tests could also be one of the main SRHR challenges faced by youth. This finding highlights the need for STIs and HIV self-testing for youth in Uganda and the urgency to ensure such integration of such interventions as the government implements measures to manage the pandemics.
Although this study was essential during the lockdown, it had several limitations. The study was limited to youth who have smartphones with internet connectivity and have an understanding of English. Those with no smartphones and internet connectivity were locked out especially the rural population and any other would be participant unable to access the online form. This study only included the educated Ugandans youth, so it cannot be generalizable to the whole youth population.