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RESEARCH ARTICLE (Open Access)

Sexual and reproductive health and rights in the era of COVID-19: a qualitative study of the experiences of vulnerable urban youth in Ethiopia

Nicola Jones A , Kate Pincock https://orcid.org/0000-0002-8263-7720 A * , Workneh Yadete B , Meron Negussie C , Estibel Mitiku D and Tsinu AmdeSelassie B
+ Author Affiliations
- Author Affiliations

A ODI, London, UK.

B GAGE, Addis Ababa, Ethiopia.

C UNFPA, Addis Ababa, Ethiopia.

D Ministry of Women, Children and Youth/UNDP, Addis Ababa, Ethiopia.

* Correspondence to: k.pincock.gage@odi.org.uk

Handling Editor: Christy Newman

Sexual Health 19(6) 509-516 https://doi.org/10.1071/SH22028
Submitted: 14 February 2022  Accepted: 24 July 2022   Published: 23 August 2022

© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background: Youth who have migrated from rural to urban areas in Ethiopia are often precariously employed, lack access to sexual and reproductive health services, and are at heightened risk of sexual violence. However, little is known about the sexual and reproductive health consequences of the coronavirus disease 2019 (COVID-19) pandemic, and associated lockdowns and service disruptions for urban-dwelling socially disadvantaged youth.

Methods: This paper draws on qualitative virtual research with 154 urban youths aged 15–24 years who were past and present beneficiaries of United Nations Population Fund-funded programs, and 19 key informants from the city bureaus and non-governmental organisations in June 2020. Semistructured interviews by phone explored the impact of COVID-19 on young people’s sexual and reproductive health and rights.

Results: The pandemic has affected the availability of sexual and reproductive health information and services, and exacerbated fears about attending clinics, particularly disadvantaging youth living with HIV and those involved in commercial sex work. Many young people have also lost their livelihoods, with some moving into transactional and survival sex. Sexual violence further undermines the rights and well-being of youth who are already marginalised, with street-connected youth, young people involved in commercial sex work and youth with disabilities particularly at risk.

Conclusion: There is an urgent need to quickly resume front-line services, and social assistance measures must include young people, if Ethiopia is to continue meeting its own objectives around adolescent and youth sexual and reproductive health.

Keywords: commercial sex work, disability, domestic workers, Ethiopia, pandemic, SRHR, street-connected, vulnerability, youth.


References

[1]  Oqubay A. Adaptive leadership in the Covid-19 response: insights from Ethiopia. ODI Insights. London: Overseas Development Institute; 2020. Available at www.odi.org/blogs/16974-adaptive-leadership-covid-19-response-insights-ethiopia

[2]  UNDP – United Nations Development Programme. Ethiopia national human development report 2018: industrialisation with a human face. Addis Ababa: UNDP; 2018. Available at https://www.undp.org/ethiopia/publications/ethiopia-national-human-development-report-2018

[3]  Bezu S, Holden S. Are rural youth in Ethiopia abandoning agriculture? World Dev 2014; 64 259–272.
Are rural youth in Ethiopia abandoning agriculture?Crossref | GoogleScholarGoogle Scholar |

[4]  Abebe H, Shumet S, Nassir Z, Agidew M, Abebaw D. Prevalence of depressive symptoms and associated factors among HIV-positive youth attending ART follow-up in Addis Ababa, Ethiopia. AIDS Res Treat 2019; 2019 4610458
Prevalence of depressive symptoms and associated factors among HIV-positive youth attending ART follow-up in Addis Ababa, Ethiopia.Crossref | GoogleScholarGoogle Scholar |

[5]  Grabska K, de Regt M, del Franco N. Adolescent girls’ migration in the global south: transitions into adulthood. Palgrave studies on children and development. Cham: Palgrave Macmillan; 2018.

[6]  de Regt M, Mihret FB. Agency in constrained circumstances: adolescent migrant sex workers in Addis Ababa, Ethiopia. J East Afr Stud 2020; 14 512–528.
Agency in constrained circumstances: adolescent migrant sex workers in Addis Ababa, Ethiopia.Crossref | GoogleScholarGoogle Scholar |

[7]  van Blerk L. Livelihoods as relational Im/mobilities: exploring the everyday practices of young female sex workers in Ethiopia. Ann Am Assoc Geogr 2016; 106 413–421.
Livelihoods as relational Im/mobilities: exploring the everyday practices of young female sex workers in Ethiopia.Crossref | GoogleScholarGoogle Scholar |

[8]  van Blerk L. Poverty, migration and sex work: youth transitions in Ethiopia. Area 2008; 40 245–253.
Poverty, migration and sex work: youth transitions in Ethiopia.Crossref | GoogleScholarGoogle Scholar |

[9]  Atnafu A, Oucho L, Zeitlyn B. Poverty, youth and rural-urban migration in Ethiopia. Working Paper 17, Research programme consortium migrating out of poverty. Brighton: University of Sussex; 2014.

[10]  Swann OV, Holden KA, Turtle L, et al. Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study. BMJ 2020; 370 m3249
Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study.Crossref | GoogleScholarGoogle Scholar |

[11]  World Bank. COVID-19 crisis through a migration lens. Migration and development, brief No. 32. Washington DC: World Bank; 2020. Available at https://openknowledge.worldbank.org/handle/10986/33634

[12]  Di Nunzio M. “We are good at surviving”: street hustling in Addis Ababa’s inner city. Urban Forum 2012; 23 433–447.
“We are good at surviving”: street hustling in Addis Ababa’s inner city.Crossref | GoogleScholarGoogle Scholar |

[13]  Government of Ethiopia. National adolescent and youth health strategy (2016–2020). Addis Ababa: Federal Democratic Republic of Ethiopia, Ministry of Health; 2016.

[14]  Yimer AS, Modiba LM. Modern contraceptive methods knowledge and practice among blind and deaf women in Ethiopia. A cross-sectional survey. BMC Women’s Health 2019; 19 151
Modern contraceptive methods knowledge and practice among blind and deaf women in Ethiopia. A cross-sectional survey.Crossref | GoogleScholarGoogle Scholar |

[15]  Kassa TA, Luck T, Bekele A, Riedel-Heller SG. Sexual and reproductive health of young people with disability in Ethiopia: a study on knowledge, attitude and practice: a cross-sectional study. Glob Health 2016; 12 5
Sexual and reproductive health of young people with disability in Ethiopia: a study on knowledge, attitude and practice: a cross-sectional study.Crossref | GoogleScholarGoogle Scholar |

[16]  UNFPA – United Nations Population Fund Ethiopia. Rapid assessment. Integrated programme on sexual and reproductive health and sexual and gender-based violence prevention and management among vulnerable groups in Addis Ababa, Amhara, Tigray and SNNP regions. Consolidated Report. Addis Ababa: UNFPA Ethiopia; 2019.

[17]  Chimdessa A, Cheire A. Sexual and physical abuse and its determinants among street children in Addis Ababa, Ethiopia 2016. BMC Pediatr 2018; 18 304
Sexual and physical abuse and its determinants among street children in Addis Ababa, Ethiopia 2016.Crossref | GoogleScholarGoogle Scholar |

[18]  Kimera E, Vindevogel S, Engelen A-M, et al. HIV-related stigma among youth living with HIV in Western Uganda. Qual Health Res 2021; 31 1937–1950.
HIV-related stigma among youth living with HIV in Western Uganda.Crossref | GoogleScholarGoogle Scholar |

[19]  Low F, McCracken M, Gummerson R, et al. Association between severe drought and HIV prevention and care behaviors in Lesotho: a population-based survey 2016–2017. PLoS Med 2019; 16 e1002727
Association between severe drought and HIV prevention and care behaviors in Lesotho: a population-based survey 2016–2017.Crossref | GoogleScholarGoogle Scholar |

[20]  de Walque D, Dow WH, Gong E. Coping with risk: the effects of shocks on reproductive health and transactional sex in rural Tanzania. Policy research working paper 6751. Washington DC: World Bank; 2014.

[21]  Robinson J, Yeh E. Transactional sex as a response to risk in Western Kenya. Am Econ J Appl Econ 2011; 3 35–64.
Transactional sex as a response to risk in Western Kenya.Crossref | GoogleScholarGoogle Scholar |

[22]  Marcus R, Gavrilovic M. The impacts of the economic crisis on youth: review of evidence. London: Overseas Development Institute; 2010.

[23]  UNFPA. Impact of the COVID-19 pandemic on family planning and ending gender-based violence, female genital mutilation and child marriage. New York: UNFPA; 2020. Available at www.unfpa.org/resources/impact-covid-19-pandemic-family-planning-and-ending-gender-based-violence-female-genital

[24]  Vindrola-Padros C, Chisnall G, Cooper S, et al. Carrying out rapid qualitative research during a pandemic: emerging lessons from COVID-19. Qual Health Res 2020; 30 2192–2204.
Carrying out rapid qualitative research during a pandemic: emerging lessons from COVID-19.Crossref | GoogleScholarGoogle Scholar |

[25]  Comins CA, Rucinski KB, Baral S, Abebe SA, Mulu A, Schwartz SR. Vulnerability profiles and prevalence of HIV and other sexually transmitted infections among adolescent girls and young women in Ethiopia: a latent class analysis. PLoS ONE 2020; 15 e0232598
Vulnerability profiles and prevalence of HIV and other sexually transmitted infections among adolescent girls and young women in Ethiopia: a latent class analysis.Crossref | GoogleScholarGoogle Scholar |

[26]  Kidd R, Clay S. Understanding and challenging HIV stigma. Washington DC: International Center for Research on Women, Manoff Press; 2003.

[27]  Ambaw F, Mossie A, Gobena T. Boyfriends, virginity values, and stigma related to condoms among Jimma University students. Ethiop J Health Sci 2010; 20 169–177.
Boyfriends, virginity values, and stigma related to condoms among Jimma University students.Crossref | GoogleScholarGoogle Scholar |

[28]  Onyango MA, Resnick K, Davis A, Shah RR. Gender-based violence among adolescent girls and young women: a neglected consequence of the West African Ebola outbreak. In: Schwartz DA, Anoko JN, Abramowitz SA, editors. Pregnant in the time of Ebola. New York: Springer; 2019. pp. 121–132.

[29]  Sochas L, Channon AA, Nam S. Counting indirect crisis-related deaths in the context of a low-resilience health system: the case of maternal and neonatal health during the Ebola epidemic in Sierra Leone. Health Policy Plan 2017; 32 iii32–iii39.
Counting indirect crisis-related deaths in the context of a low-resilience health system: the case of maternal and neonatal health during the Ebola epidemic in Sierra Leone.Crossref | GoogleScholarGoogle Scholar |

[30]  Wilson N. The World’s oldest profession? Employment-age profiles from the transactional sex market. IZA J Labor Policy 2019; 9 1–17.
The World’s oldest profession? Employment-age profiles from the transactional sex market.Crossref | GoogleScholarGoogle Scholar |

[31]  Baru A, Adeoye IA, Adekunle AO. “I was raped by the broker on the first day of my arrival in the town.” Exploring reasons for risky sexual behavior among sexually-active unmarried young female internal migrants in Ethiopia: a qualitative study. PLoS ONE 2020; 15 e0242176
“I was raped by the broker on the first day of my arrival in the town.” Exploring reasons for risky sexual behavior among sexually-active unmarried young female internal migrants in Ethiopia: a qualitative study.Crossref | GoogleScholarGoogle Scholar |