The 1994 International Conference for Population and Development (ICPD) set the stage for putting adolescent sexual and reproductive health (SRH) on the international agenda. During the conference it was recognised that reproductive health needs of young people had largely been ignored by existing health, education and other social programmes. The conference adopted a plan of action which has formed the basis for programmes addressing the SRH needs of adolescents globally . The five year progress review of this plan (ICPD + 5) made a further call for governments to ensure that adolescents have access to user-friendly services that effectively address their SRH needs including reproductive health information, education and counselling and health promotion activities, while encouraging their active participation . A subsequent review conducted 10 years later (ICPD + 15) showed that teenage births were still a major concern, especially in sub-Saharan Africa where rates of more than 120 births per 1000 women aged 15–19 years are recorded and young people continue to be at risk for HIV infection, especially adolescent girls [3–5].
There is no single definition of SRH services but within the literature, SRH is described by the amalgamation of “sexual health” and “reproductive health”. Sexual health has been defined by the World Health Organization (WHO) as “a state of complete physical, emotional, mental and social well-being in relation to sexuality; not merely the absence of disease, dysfunction or infirmity”. A positive and respectful approach to sexuality and sexual relationships is of paramount importance with the possibility of having safe sexual experiences which are free from discrimination, coercion and violence, and allowing for a sexual life that is safe and satisfying, with the freedom to decide if, when and how often to reproduce [1, 6]. The ICPD Programme of Action included sexual health as part of the wider definition of reproductive health . Adolescent SRH services therefore aim to provide information, education and health services to adolescents to help them understand their sexuality and protect them from unintended pregnancy and/or sexually transmitted infections including HIV/AIDS. It is recommended that this is combined with education of young men to respect women’s self-determination and to share responsibility with women in matters of sexuality and reproduction [1, 7, 8]. Youth friendly SRH services have been described by WHO (2002) as “services that are accessible, acceptable, equitable and appropriate to meet the SRH needs of young people aged between 10–24 years.” Such services are provided within an environment that is friendly and welcoming so that young people are able to come back again and also refer their friends for the same services . Elements such as adolescent friendly policies, friendly health service providers and support staff, friendly service delivery mechanisms such as convenient opening hours, privacy and comprehensiveness of services have been cited as essential [6, 7].
Kenya’s population is estimated at 38.6 million  and is projected to reach 56.5 million by the year 2025 . Young people aged 15–24 years comprise almost 21 percent of the total population, out of which 51 and 49 percent are female and male respectively . The Kenya Demographic Health Survey (KDHS) has shown a reduction in the percentage of teenagers aged 15–19 who have begun childbearing, from 23 percent (KDHS 2003) to 18 percent (KDHS 2008–09), with no difference between urban and rural populations.
Contraceptive use (any modern method) among sexually active girls aged 15–19 years, has increased from 20 percent in 2003 to almost 25 percent in 2008–09. Currently married women aged 15–19 mostly use the injectable contraceptive (14.4%), while unmarried women in the same age group commonly use the male condom (19.6%). Among currently married women, the unmet need for contraception among girls aged 15–19 years is 30 percent . The HIV prevalence among young people aged 15–24 years is 3.8%, with women (5.6%) being four times more likely to be infected than young men of the same age (1.4%) . Although the majority (90%) of young people aged 15–24 years know where to obtain an HIV test, less than five out of ten have ever gone for an HIV test and received a result .
Studies on sexually transmitted infections (STIs) among young people in Kenya are limited but current data shows that 12.6 percent of girls and 5.5 percent of boys aged 15–19 years are infected with HSV-2, while 0.6 percent of young people aged 14–24 years are infected with syphilis . Young people are at increased risk of contracting STIs and in many countries age specific incidence and prevalence rates of STIs tend to be highest in the age group 15–24 years [11, 12].
Girls aged 15–19 are twice as likely to die from pregnancy related complications compared to women in their 20s, while for girls aged 14 and below, this risk is increased fivefold . In addition, children born of adolescent mothers are more likely to be underweight and die before their fifth birthday. Although adolescence is a stage in life where young people may be exposed to a number of risks and dangers, there is potential for promotion of healthy behaviour through appropriate education [14, 15]. Behaviour initiated or learnt during adolescence may be long lasting and have either negative or positive influences on young people’s future lives. Efforts therefore have to be focused on promoting healthy and preventive behaviour during this stage of life .
Generally, HSPs approaches to addressing adolescent SRH have been found to be rather conservative in nature. Although nurses consider responding to adolescent sexual needs part of their routine nursing care, majority still face difficulties for example, in initiating discussions between adolescents while some feel discussions around sexuality should be the responsibility of the parents . Adolescents are often not provided with the services they need, especially contraceptives and abortion, even where abortion is legal. Health providers have widely acknowledged the fact that they are not well equipped with knowledge and skills to effectively provide SRH services to adolescents [11, 18].
A study carried out in Kenya and Zambia showed that nurse-midwives regard adolescent sexuality as a ‘moral issue’ and disapprove of adolescent pre-marital sex, abortion, and safer sex practices including contraceptive use .
A systematic review of interventions to increase young people’s use of health services in developing countries has shown that a combination of interventions, including health service provider training, facility improvement initiatives and community-wide health education can lead to increased service uptake. The need for careful monitoring, evaluation and operations research was also highlighted in this review . Health care provider training on youth-friendly services (YFS) that are linked to other service components such as education in schools and the community, significantly increases service use especially among younger males (15-19 yrs) .
In the National Health Sector Strategic Plan II 2005–2010 (NHSSP II), adolescent SRH has been recognised as a priority within the Kenya Essential Package of Health (KEPH) . Within the KEPH the Ministry of Health commits itself to providing services that are specific to this age group including reproductive health counselling, contraceptives and HIV/AIDS related services. This is to be achieved through the establishment of youth-friendly SRH health services within existing health facilities. According to the NHSSP II (2005–2010), the government intended to increase the number of facilities providing youth-friendly services from five in 2004 to 60 in the year 2010 . In spite of this commitment, there is still some scepticism among planners, policy makers and development partners with regards to allocating resources to SRH services targeting young people. One of the reasons for this reluctance to allocate resources could be that stakeholders are not fully convinced about the model of service provision . In addition to this, there is limited documentation on the state of SRH services for young people in Kenya.
This study was part of a larger research programme in Kenya, designed to explore the SRH needs of young people, perceptions of available SRH services from the perspective of young people themselves, community members and HSPs in order to provide more information on how best SRH services could be provided to young people in Kenya. This paper focuses on the perspectives and experiences of HSPs.