Universal access to sexual and reproductive health is a fundamental human right. However, access to sexual reproductive health services remains a challenge in many places of the world. First, sexual and reproductive health (SRH) services are not always available. Second, even in case of availability SRH services might not be accessed or utilized. Reasons are often multifactoral and difficult to disentangle as they range from individual factors (such as stigma, embarrassment, or fear) to structural barriers (e.g., the availability of transportation, costs but also policy regulations).
This thesis compromises four selected original publications exploring barriers to SRH services in two very different settings: a) migrant women in Geneva, Switzerland, consulting a gynecology or obstetrics department; b) women aged between 30 – 49 years, invited for cervical cancer screening, living in the Dschang district, Cameroon.
The collection aims to review the previous research work with a more global approach. Hereby, the principal objective is - despite the different settings’- to explore common barriers to SRH services. Furthermore, the secondary objective is to understand whether classifying the encountered limiting factors in the Dahlgren and Whitehead model of social determinants is helpful to identify additional interventions or research opportunities for SRH services or programs.
In conclusion, the selected publications revealed three common barriers to SRH services: financial considerations, insufficient quality of SRH services and the inadequate comprehension of SRH services. Despite the limitations of the Dahlgren and Whitehead model, the utilization of the framework allowed to suggest additional interventions or research opportunities for the two healthcare settings. Those were identified as direct interventions on the level of healthcare professionals providing SRH care; specifically, the implementation of training to (i) address discrimination and stigma and (ii) to improve the quality of communication of healthcare professionals. (Figure 5) Furthermore, research opportunities were mainly suggested at the programmatic management level of SRH services health programs or institutions. Hereby, future research was especially suggested to (i) analyze forms and levels of discrimination and stigma (ii) quantify and evaluate specific health literacy interventions e.g., the usability of universal precaution tools and (iii) explore the role of indirect costs as a barrier to SRH services.
