The utilization of Youth Friendly Health Services among illiterate adolescents in Rwanda remains low at 25.3%, with key barriers including providers' negative attitudes, internalized stigma, and lack of materials tailored to illiterate adolescents.
The proportion of YFHS utilization among illiterate adolescents in Rwanda was 25.3%.
The quality of sexual and reproductive health services observed in YFHS centers was rated at only 24.36%.
Having information about family planning was the strongest predictor of YFHS utilization among illiterate adolescents.
Ever having heard about YFHS and use of contraceptives were independently associated with YFHS utilization.
Qualitative findings identified providers' negative attitudes, internalized stigma, and lack of literacy-appropriate materials as key barriers to YFHS access.
Key facilitators to accessing YFHS included having information about adolescent sexual and reproductive health, free-of-charge services, and peer educators.
Study participants suggested community awareness, staff training, entertainment-based approaches, and increasing the number of YFHS as ways to improve service uptake.
This research suggests that illiterate adolescents in Rwanda face significant challenges in accessing and using Youth Friendly Health Services (YFHS) — specialized centers designed to provide young people with sexual and reproductive health information and care. Only about one in four illiterate adolescents (25.3%) reported using these services, and the quality of care observed at the 16 centers studied was also rated very low (24.36%). The study used both surveys and focus group discussions led by illiterate adolescents themselves to understand why utilization is so low. The research found that adolescents who had heard about YFHS, had access to reproductive health information, knew about family planning, or had used contraceptives were significantly more likely to use these services. On the other hand, major barriers included negative or judgmental attitudes from healthcare providers, feelings of shame or stigma among the adolescents themselves, and the near-total absence of health education materials designed for people who cannot read. Peer educators, free services, and having prior health knowledge were identified as factors that helped adolescents overcome these barriers. This research suggests that simply having YFHS centers in place is not enough — the quality and accessibility of those services must be improved, especially for marginalized groups like illiterate youth. Practical steps identified include training healthcare staff to be more welcoming and non-judgmental, developing picture-based or audio health materials, expanding peer education programs, raising community awareness, and opening more centers. The participatory approach — involving illiterate adolescents as active researchers — also highlights the value of centering the voices of the communities being studied when designing health interventions.
Mukeshimana M, Nkurunziza A, Nyiringango G, Karamage E, Asingizwe D, Nshutiyukuri C, et al.. (2025). Access and utilization of youth friendly sexual and reproductive health services among illiterate adolescents in Rwanda: A mixed-methods participatory study.. PloS one. https://doi.org/10.1371/journal.pone.0325184