Understanding barriers to young people's utilisation of sexual and reproductive health services in Asia-Pacific countries: a qualitative systematic review and thematic synthesis.

abstractIntroduction: Based on the United Nations' sustainable development goals, universal access to sexual and reproductive health (SRH) services should be attained by 2030. Yet, large inequalities in adolescent SRH knowledge and service use still exist both within and between countries. The goal of this study was to identify and synthesise published qualitative research on factors affecting young people's utilisation of SRH services in Asia-Pacific countries. Methods: We systematically searched five electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL and Web of Science) for qualitative studies reporting the experiences, attitudes and views of young people (aged 10-24 years) regarding the utilisation of SRH services in Asia-Pacific countries. We assessed the quality of identified studies using the Critical Appraisal Skills Programme qualitative checklist and employed a thematic synthesis approach for the data analysis. Results: We included 31 articles that reported the experiences of over 1800 young people from 15 different countries. Thematic synthesis identified six descriptive themes that captured factors influencing SRH service utilisation: (1) navigating puberty; (2) knowledge and beliefs about SRH; (3) embarrassment and confidentiality concerns; (4) low decision-making autonomy; (5) traditional practices and religious beliefs; and (6) social and gender norms. Based on these, we developed an overarching analytical theme, 'trapped in a legacy of shame', which highlights the role of shame as a key emotion associated with young people's utilisation of SRH services. Conclusion: Our findings point towards the necessity of integrating shame-sensitive approaches and a social norms perspective in interventions aiming to improve young people's SRH outcomes in Asia-Pacific countries. PROSPERO registration number: CRD42023389653.