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Review
. 2025 Dec;33(1):2520682.
doi: 10.1080/26410397.2025.2520682. Epub 2025 Aug 1.

Stated preferences of adolescents and young adults for sexual and reproductive health services in Africa: a systematic review

Melaku Birhanu Alemu  1 , Richard Norman  2 , Jaya Dantas  3 , Daniel Gashaneh Belay  4 , Tsegaye G Haile  5 , Gavin Pereira  6 , Gizachew A Tessema  7
Affiliations
Review

Stated preferences of adolescents and young adults for sexual and reproductive health services in Africa: a systematic review

Melaku Birhanu Alemu et al. Sex Reprod Health Matters. 2025 Dec.

Abstract
in English, French, Spanish

Adolescents and young adults (AYAs) constitute approximately 30% of the African population and face significant challenges in accessing sexual and reproductive health (SRH) services. Low service uptake, despite availability, may indicate service provision misalignment with AYAs' preferences. This reflects the health sector gap and will partly compromise AYAs' rights. This study synthesised stated preference studies on SRH services among AYAs in Africa, following the PRISMA 2020 guidelines. Searches were conducted across six databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus and Global Health) and Google Scholar for grey literature on 24 April 2024. The attributes used to measure SRH preferences were classified based on the Donabedian quality of healthcare framework. A risk of bias assessment was conducted to evaluate the quality of included studies. The review was registered in PROSPERO (CRD42023386944). From 8,329 identified records, 16 studies with 8,005 participants from six countries were included in the final analysis. The attributes used were related to the structural (44.3%), process (41.7%) and outcome-related (13.9%) dimensions. The most important attributes were the cost of services, effectiveness of treatment and treatment frequency. Conversely, the least important attributes were treatment side effects, treatment and medical test sample collection characteristics, provider characteristics (age, gender and profession), and incentive type and recipient. In conclusion, AYAs' preferences were mainly influenced by cost, treatment effectiveness and incentive distribution methods. Policymakers need to develop affordable and effective SRH programmes with tailored incentives to align with AYAs' preferences to improve service uptake. However, these insights reflect data from a limited range of African countries.

Les adolescents et les jeunes adultes forment près de 30% de la population africaine et rencontrent d’importants obstacles pour accéder aux services de santé sexuelle et reproductive (SSR). Le faible recours aux services, en dépit de leur disponibilité, peut indiquer une inadéquation de la prestation des services avec les préférences des adolescents et des jeunes adultes. Cela reflète les lacunes du secteur de la santé et compromet en partie les droits de ce groupe de population. Cet examen a synthétisé les études sur les préférences déclarées en matière de services de SSR chez les adolescents et les jeunes adultes en Afrique, conformément aux directives PRISMA 2020. Des recherches ont été menées dans six bases de données (MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, Global Health) et Google Scholar pour la littérature « grise » le 24 avril 2024. Les attributs utilisés pour mesurer les préférences en matière de SSR ont été classés selon le cadre de Donabedian pour la qualité des soins de santé. Une évaluation du risque de biais a été réalisée pour estimer la qualité des études incluses. L’examen a été enregistré dans PROSPERO (CRD42023386944). Sur 8329 dossiers identifiés, 16 études portant sur 8005 participants de six pays ont été incluses dans l’analyse finale. Les attributs utilisés étaient liés aux dimensions structurelles (44,3%), procédurales (41,7%) et relatives aux résultats (13,9%). Les attributs les plus importants étaient le coût des services, l’efficacité du traitement et la fréquence du traitement. À l’inverse, les attributs les moins importants étaient les effets secondaires du traitement, les caractéristiques du traitement et du prélèvement des échantillons de tests médicaux, les caractéristiques des prestataires (âge, genre, profession), ainsi que le type d’incitation et le bénéficiaire de ces mesures. En conclusion, les préférences des adolescents et des jeunes adultes étaient principalement influencées par le coût, l’efficacité du traitement et les méthodes de distribution des incitations. Les décideurs politiques doivent mettre au point des programmes de SSR abordables et efficaces, avec des incitations adaptées pour s’aligner sur les préférences des adolescents et des jeunes adultes, de façon à améliorer l’utilisation des services. Néanmoins, ces informations reflètent des données provenant d’un nombre limité de pays africains.

Los adolescentes y jóvenes adultos (AJA) constituyen aproximadamente el 30% de la población africana y enfrentan considerables retos para acceder a los servicios de salud sexual y reproductiva (SSR). La baja aceptación de servicios, a pesar de su disponibilidad, podría indicar la desalineación de la prestación de servicios con las preferencias de AJA. Esto refleja la laguna en el sector salud y comprometerá parcialmente los derechos de AJA. Este estudio sintetizó los estudios de las susodichas preferencias con relación a los servicios de SSR entre AJA en África, después de publicadas las directrices PRISMA de 2020. El 24 de abril de 2024, se realizaron búsquedas en seis bases de datos (MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, Global Health) y en Google Scholar para la literatura gris. Los atributos utilizados para medir las preferencias de SSR fueron clasificados según el marco Donabedian de calidad de la atención a la salud. Se realizó una evaluación del riesgo de sesgo para evaluar la calidad de los estudios incluidos. La revisión se registró en PROSPERO (CRD42023386944). De los 8329 registros identificados, se incluyeron en el análisis final 16 estudios con 8005 participantes provenientes de seis países. Los atributos utilizados estaban relacionados con las dimensiones estructurales (44.3%), procesales (41.7%) y relacionadas con los resultados (13.9%). Los atributos más importantes eran: el costo de los servicios, la eficacia del tratamiento y la frecuencia del tratamiento. En cambio, los atributos menos importantes fueron: los efectos secundarios del tratamiento, las características del tratamiento y de la recogida de muestras de exámenes médicos, las características de los prestadores de servicios (edad, género, profesión), el tipo de incentivo y el beneficiario. En conclusión, las preferencias de AJA eran influenciadas principalmente por costo, eficacia del tratamiento y métodos de distribución de incentivos. Los formuladores de políticas deberían crear programas de SSR asequibles y eficaces, con incentivos adaptados para alinearse con las preferencias de AJA, a fin de mejorar la aceptación de los servicios. Sin embargo, estas perspectivas reflejan los datos de una gama limitada de países africanos.

Keywords: Africa; SRH; adolescents and young adults; discrete choice experiments; preferences; sexual and reproductive health; stated preferences; young people; youth.

Plain language summary

Adolescents and young adults (AYAs) account for around 30% of Africa's population. Yet, a substantial proportion of them face challenges in getting sexual and reproductive health (SRH) services. Although SRH services are part of primary healthcare services, many AYAs do not benefit from these services. A key reason for the low uptake of SRH services may be a mismatch between existing service arrangements and AYAs’ preferences. We reviewed available studies that were undertaken using hypothetical choice-based scenarios. We searched six bibliographic databases for published studies: MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus and Global Health. We also searched Google Scholar for grey literature. We found 16 studies involving 8005 participants from six African countries. The review found that the cost of services, treatment types and visit frequency are key factors shaping AYA preferences. In contrast, we found that AYAs cared least about treatment side effects, the provider's profile, including age and gender, and incentives. In conclusion, AYAs perceived that they would choose SRH services based on cost, effectiveness and incentives. Policymakers should provide effective, affordable treatment options for AYAs to improve the utilisation rate of SRH services among AYAs in Africa. It is also worthwhile to provide incentives to attract AYAs to use SRH facilities in Africa.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram
Figure 2.
Figure 2.
Construction of the discrete choice experiment questionnaire. N/R: Not reported
Figure 3.
Figure 3.
Most important attributes for SRH service use among adolescents and young adults in Africa
Figure 4.
Figure 4.
Frequency of the least important attributes for SRH service use among adolescents and young adults in Africa
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