Reproductive Health Services: Expectations and Experiences Among in-school and Out-of-school Adolescents in Nigeria

Background: Adolescents peculiar health needs require adolescent reproductive health services (ARHS). Despite the growing adolescent population, they have limited access to health services. In Nigeria, one in three children are out-of-school. Therefore, this study aimed to compare reproductive health service expectations and experiences among in-school and out-of-school adolescents. Methods: This was a comparative cross-sectional study among adolescents aged 10-19 years. In-school adolescents were selected via a multistage sampling technique, whereas out-of-school adolescents in the mapped area were selected. A WHO illustrative questionnaire for interviews with young people was used to collect data. The SERVQUAL tool was used to measure the gap between expectations and perceptions of the services delivered. Results: Six hundred forty adolescents were recruited. More in-school adolescents (80.6%) than out-of-school adolescents (63.4%) were aware of ARHS (p<0.001). The mean ARHS expectations score of out-of-school adolescents was higher than that of in-school adolescents (t=2.824; p=0.005). A greater proportion of out-of-school compared with in-school adolescents expected to receive ARHS from a young and same-sex health professional (p<0.001). More in-school adolescents (52.8%) than out-of-school adolescents (18.8%) had ARHS experiences (p<0.001). More out-of-school adolescents than in-school adolescents received warmth and empathy from from health professionals (p=0.025). A greater proportion of out-of-school adolescents than in-school adolescents considered the ARHS satisfactory (p=0.017). Conclusions: Increased expectations of ARHS among out-of-school adolescents do not translate to increased utilisation of ARHS. This, therefore, calls for more community outreach to out-of-school adolescents.