1. Introduction

Adolescents are at higher risk of sexual reproductive health (SRH) issues, including unwanted pregnancy, unsafe abortion, STIs, and sexual violence, due to their increased sexual activity [1]. Young people aged 15–24 make up 15.5% of the global population, with a high proportion in developing countries like Ethiopia accounting for 33% of the total population [2].

The 1994 ICPD in Cairo recognized adolescent-friendly reproductive health (RH) services as an effective strategy for addressing adolescent sexual and reproductive health (ASRH) needs [3], ensuring universal access to quality services without discrimination [4]. Youths worldwide face health issues, including early puberty and premarital sex, but unmet contraceptive needs are twice as high as married women’s. Thirty-three percent of new HIV infections occur among youths [5].

In 2016, the prevalence of teenage pregnancy was 19.3% and 21.5% in SSA and East Africa, respectively [6]. Nearly half of the pregnancies among youths aged 15–19 in SSA were unintended [7]. Pregnancy-related deaths are the second-leading cause of death among female youths [8].

SRH disparities exist between developed and developing countries. In developed countries, access to education, healthcare, and contraception leads to better outcomes, but socioeconomic and cultural disparities can still impact SRH outcomes [9, 10]. In developing countries, poor SRH outcomes are often exacerbated by sociocultural barriers, including limited access to sexual education, healthcare services, contraception, early marriage, gender inequality, and inadequate healthcare infrastructure [11, 12, 13].

Youths’ access to and use of SRH services is a worldwide concern [10]. Ethiopia offers comprehensive SRH services to youths and adolescents, including information, family planning, condom promotion, pregnancy tests, HIV management, antenatal care, and abortion services [11].

The EDHS 2016 report shows low HIV knowledge among adolescents and youths, particularly rural females, with only 16% having comprehensive knowledge. However, over 90% of urban youths and 69% of rural females know where to get voluntary counseling and testing (VCT) for HIV [14].

In 2018, Ethiopia had 690,000 HIV-positive adults, with 63.88% of them being women and 23,000 were newly infected, leading to 11,000 deaths from AIDS-related illnesses [15]. Adolescent girls and young women aged 15–24 are up to three times more likely to be HIV positive compared to their male counterparts [16].

Adolescent sexual reproductive health rights (ASRHRs) are a key component of some Sustainable Development Goals (SDGs), and these indicators are recommended for Goal 3 on health and Goal 5 on gender equality [12].

Ethiopia has health extension workers providing preventive care and a national adolescent and youth RH strategy, but access to these services is limited. Despite efforts to improve services, high rates of child marriage persist, especially in rural areas [17, 18].

Ethiopia has been enhancing the utilization of ASRH services for underserved adolescent and youth populations since 2018, with collaboration from health partners and the Ethiopian government [19]. The study is aimed at assessing factors associated with the utilization of ASRH services in Ethiopia, following limited evidence post-COVID-19, the war between the government and Tigray, and the sensitive topic of many 12th-grade female students giving birth during university entrance exams.

2. Methods and Materials

2.6. Sampling Procedure

A multistage sampling method was applied to select a representative sample of adolescent high school students. In the first stage, high schools in Bahir Dar City were clustered into two groups (regular and irregular), and from each cluster, one school was selected by a simple random sampling method, making a total of two schools. Secondly, high school students were stratified by their grade level of attendance. Then, the sample size was allocated proportionally after obtaining the list of students from the respective school administration. Finally, the study participants were selected from each grade by using simple random sampling from the sampling frame of the student roster (Figure 1).

3. Results

3.3. Magnitude of ASRH Service Utilization

The magnitude of ASRH service utilization was found to be 30.4% (184) with a 95% CI of 26.7 and 34.2. The most frequently used components of ASRH services were family planning services, education, and counseling regarding ASRH, followed by miscarriage and postabortion care services, vaccination, getting a condom, VCT for HIV, STI treatment and counseling, and getting mental health and psychosocial support (Figure 2).

4. Discussion

The results of the study revealed that the proportion of high school students who utilized ASRH services was found to be 30.4% (184) with a 95% CI (26.7, 34.2). This finding was higher than the study findings from Mecha district (8.4%) [23], Machakel district (21.5%), east Gojjam zone [24], Mekele (22%) [25], western Ethiopia (8.6%) [26], South Gondar (24.6%), Wereta Ethiopia [27], Dawuro zone (26%), southwest Ethiopia [28], Haramaya district (23.5%) [29], and Nekemte town (21.2%) in Oromia region [30]. This difference might be due to the presence and exertion of nongovernmental organizations (NGOs) like the Family Guidance Association (FGA) in Ethiopia, which have increased their contribution to the expansion of adolescent and youth sexual and reproductive service provision in the study area.

This might significantly alter how often ASRH services are used compared to the earlier findings. Besides this, the result of this study was higher compared to that of other studies done in urban Nepal (9.2%) [31] and Makassar, Indonesia [32]. This discrepancy might be due to the difference in sociodemographic characteristics of participants and the study settings in terms of the availability and accessibility of ASRH service facilities. Also, the study in Nepal’s Bhaktapur district found that, during the survey, youth-friendly health services were not properly integrated into urban clinics. This may also be the reason for the lower utilization of ASRH services.

On the other hand, this finding was lower than the study findings of 48.9% in Addis Ababa [31] and 54.6% in the Amhara region, northwest Ethiopia [20]. This difference might be due to age and maturity differences. For instance, the study in Addis Ababa was carried out among undergraduate students at Addis Ababa University, whose age and maturity are substantially higher than those of the study participants. University students may also have a high level of peer influence and a high sense of risk despite being generally free from family and community factors. All of these could have affected how people used SRH services. The majority of the out-of-school adolescents studied in the Amhara area of northwest Ethiopia may have had sexual exposure and may be married.

The results of this study indicate a lower prevalence compared to previous research, including rates of 32.2% in Bahir Dar [34] and 32.7% (ranging from 29.0% to 36.6%) in the North Shewa Zone [35]. Additionally, the findings are notably lower than those reported in Enugu State, Nigeria (86.7%) [36], and Ghana (55.8%) [37]. This disparity may stem from various factors, such as sociocultural barriers, perceptions among adolescents (including concerns about visibility when accessing SRH services), and challenges related to service delivery (such as provider attitudes, accessibility, and service hours).

In this study, students who had ever had sexual exposure were 6.03 times more likely to utilize the ASRH service compared with those who had not. This finding is in line with the studies conducted in Mecha district [23], western Ethiopia [26], and North Shewa [35]. These similarities might be due to the difference in risk perception. Teenagers who engage in sexual activity may perceive unintended pregnancy, abortion, HIV, and other STIs as being more dangerous than those who refrain from doing so [7, 9]. So, people might prepare and employ defensive strategies when engaging in sexual practice.

This finding showed a significant association between prior sexual exposure and the utilization of ASRH services among students. The observed trend aligns with similar studies conducted in Mecha district [23], western Ethiopia [26], and North Shewa [35], indicating a consistent pattern across different regions. This suggests that individuals with prior sexual exposure may have a heightened awareness of their RH needs, leading to a greater propensity to seek ASRH services.

In this study, the odds of ASRH service utilization were 5.93 times higher among students who participated in the RH school club compared to those who did not participate in the RH school club. This finding was in agreement with the study findings in Mecha district [23]. These similarities may be caused by the fact that students who participate in the RH school club frequently talk about issues related to SRH, obstacles to using services, and risks related to SRH; develop life skills; share experiences; and are aware of these issues. As a result, this may lead to higher ASRH service utilization.

In this study, perceived risk of SRH problems showed a significant association with ASRH service utilization. Students who perceived they were at risk of SRH problems were six times more likely to utilize the ASRH service compared with their counterpart. This might be because when adolescents perceive that they are at risk of getting SRH problems, they are more likely to utilize ASRH service like VCT.

This study also indicated that students who knew about adolescent RH services were significantly associated with ASRH service utilization. High school students who knew about adolescent RH services were about 2.37 times more likely to utilize ASRH services compared with those who did not know how to get adolescent RH services. This finding was in agreement with the study findings in Haramaya district [29]. This could be because students who know where to go to use ASRH services might have a greater possibility of utilizing ASRH services.

In this study, the odds of ASRH service utilization were 2.79 times higher among students who heard about ASRH compared with those who did not hear about ASRH. This finding was in agreement with the study findings in western Ethiopia [26], Dawuro zone [28], and Haramaya district [29]. This could be due to having a source of information that may improve adolescents’ awareness of SRH-related issues and their health-seeking behavior.

This study also indicated that students who had a history of SRH problems were significantly associated with ASRH service utilization. High school students who had a history of SRH problems were 1.6 times more likely to utilize ASRH services compared with their counterparts. This finding was consistent with the study findings in Bahir Dar [34] and North Shewa Zone [35]. This could be because having RH problems like unwanted pregnancy, STIs, and HIV pushes adolescents to seek treatment for their illnesses, which increases ASRH service utilization.

The limitations of this study include its reliance on self-reported data, which may be subject to recall bias or social desirability bias. Additionally, the study focused exclusively on high school students, which may not fully represent the broader adolescent population. Furthermore, the study’s cross-sectional design limits its ability to establish causality or determine long-term trends in ASRH service utilization. This study also did not address some behavioral variables such as chewing khat, drinking alcohol, and other substance abuse, so we recommend future researchers address them. Finally, while efforts were made to ensure the validity and reliability of the findings, the study’s reliance on a single data collection method may have introduced methodological limitations.

The study’s findings carry weighty implications. They shed light on the factors affecting the utilization of ASRH services among high school students, guiding focused interventions to enhance access. Pinpointing factors such as the involvement of NGOs enables policymakers to customize initiatives to match specific requirements, emphasizing the necessity of incorporating youth-friendly health services. Ultimately, this understanding can lead to the development of more efficient approaches for advancing ASRH.

These findings guide policymakers in crafting effective policies on ASRH. By understanding factors influencing service utilization, policymakers can prioritize partnerships with NGOs and integrate youth-friendly services, leading to improved access and outcomes for adolescents.

5. Conclusion

This study revealed that the overall magnitude of ASRH service utilization was found to be low. Reproductive health school club participation was significantly associated with sexual exposure; a history of SRH problems, being perceived as at risk of SRH problems, hearing information about ASRH, and knowing the place to get the service were significantly associated with utilization of ASRH. The purpose of this study was to assess SRH service utilization and associated factors among high school students. Hence, it is important to promote adolescent utilization of SRH services by increasing their source of information about ASRH, their perception of the risk of getting SRH problems, and their participation in the RH school club.

Ethics Statement

Ethical approval for this study was obtained from the Institution Review Board (IRB) of the Amhara Public Health Institute with Reference Number 207/2022. The written informed consent was done to be the candidate. Collected data were used for only the purpose of this study. The study participants were assured of confidentiality by excluding their names during the period of data collection. The rights are given to study participants to refuse, stop, or withdraw from the interview at any time. Confidentiality was maintained throughout the study.

Conflicts of Interest

The authors declare no conflicts of interest.

Author Contributions

A.E., Y.A., B.C., and E.K.B. participated in the conception and design of the study. A.E. carried out data collection. A.E., Y.A., B.C., and E.K.B. participated in the data analysis and interpretation. A.E., Y.A., and B.C. drafted the manuscript, and E.K.B. reviewed and edited the manuscript. All authors read and approved the final manuscript. A.E. and E.K.B. contributed equally to this work. The authors declare that they have agreed to publish in this journal.

Funding

This research received no funding from any funding agency.