Risk factors of sexual and reproductive health problems, service utilization, and its challenges among street youths in East Gojjam zone, North West Ethiopia: exploratory qualitative study.
Ewunetie A, Aschale A, et al. • BMC public health • 2025
Risk factors exposing street youths to sexual and reproductive health problems included low perceived susceptibility, lack of awareness, multiple sexual partners, pornographic film exposure, and alcohol/substance use, while most street youths were not utilizing reproductive health services due to accessibility limitations and unsupportive health professional behavior.
Key Findings
Results
Low perceived susceptibility to sexual and reproductive health risks was identified as a major risk factor among street youths in East Gojjam Zone.
Study employed a phenomenological qualitative design using inductive thematic analysis
Data collected through eight in-depth interviews and eight focus group discussions
Participants were purposively recruited from four town administrations in East Gojjam Zone
Low perceived susceptibility was identified as one of the primary themes contributing to sexual and reproductive health vulnerability
Results
Having multiple sexual partners and exposure to pornographic films were identified as behavioral risk factors for sexual and reproductive health problems among street youths.
Multiple sexual partners was identified as a major risk factor for sexually transmitted disease spread among the study population
Exposure to pornographic films was identified as a distinct risk factor theme
Limited use of condoms was noted as a major risk factor in the broader Ethiopian context
These findings emerged from eight focus group discussions and eight in-depth interviews with street youths
Results
Use of alcoholic drinks and substances was identified as a key risk factor exposing street youths to sexual and reproductive health problems.
Substance and alcohol use emerged as a distinct thematic risk factor category
This finding was derived through inductive thematic analysis of audio-recorded interviews and focus group discussions
Participants were street youths residing in East Gojjam Zone, North West Ethiopia
The study used a phenomenological design to capture lived experiences of street youths
Results
Street youths engaged in transactional sexual relationships were more likely to use condoms consistently and undergo regular HIV screening.
Consistent condom use and regular HIV screening were observed mainly among those engaged in transactional sex
This subgroup represented a notable exception to the broader pattern of low service utilization
The finding suggests that perceived financial risk or occupational awareness may motivate protective behaviors in this subgroup
Data were gathered through in-depth interviews and focus group discussions with street youths across four town administrations
Results
Most street youths were not utilizing reproductive health services, with only a few ever accessing maternal and child health services.
Low service utilization was a major finding across the study population
Only a small number of street youths had ever utilized maternal and child health services
Limitation on the accessibility of sexual and reproductive health services was identified as the main contributing factor to non-utilization
The study was conducted in four town administrations in East Gojjam Zone, Northwest Ethiopia
Results
Unsupportive behavior of health professionals, absence of accurate data on street youths, health system gaps, and lack of a specific responsible organization were identified as major challenges to sexual and reproductive health service delivery for street youths.
Four major challenge themes were identified: unsupportive health professional behavior, absence of exact data, health system inadequacies, and lack of specific responsible organization
The absence of data on street youths was noted as a systemic barrier to targeted service delivery
No specific organization was identified as having clear responsibility for the sexual and reproductive health of street youths
These challenges were identified through inductive thematic analysis of qualitative data collected from street youth participants
Results
Lack of awareness about sexual and reproductive health was identified as a key risk factor among street youths in East Gojjam Zone.
Lack of awareness was listed alongside low perceived susceptibility as a cognitive/informational risk factor
This finding emerged from phenomenological inquiry into the lived experiences of street youths
Study participants were purposively recruited, targeting street youths as the primary study unit
Eight in-depth interviews and eight focus group discussions were conducted across four town administrations
What This Means
This research explored the sexual and reproductive health experiences of young people living on the streets in East Gojjam Zone, Northwest Ethiopia. Using in-depth interviews and focus group discussions with street youths across four towns, researchers found that these young people face multiple overlapping risk factors including not believing they are personally at risk (low perceived susceptibility), lack of knowledge about sexual health, having multiple sexual partners, watching pornographic films, and using alcohol and substances. Most street youths were not accessing reproductive health services, largely because those services were not accessible to them, and health workers were often described as unsupportive.
One notable exception was that street youths involved in transactional sex (exchanging sex for money or goods) were more likely to use condoms consistently and get tested for HIV regularly, suggesting that some awareness of risk does exist within this subgroup. However, very few street youths had ever used maternal and child health services. Systemic problems also contributed to the situation, including a lack of reliable data on street youths, no specific organization responsible for their health, and broader health system gaps.
This research suggests that street youths in Ethiopia are a largely overlooked population when it comes to sexual and reproductive healthcare. The findings point to a need for health systems and policies to take active responsibility for this group, develop targeted and accessible reproductive health programs, improve health worker attitudes toward street youths, and establish clear organizational accountability for their wellbeing.
Ewunetie A, Aschale A, Desta M, Gietaneh W, Asmamaw H, Gedif G, et al.. (2025). Risk factors of sexual and reproductive health problems, service utilization, and its challenges among street youths in East Gojjam zone, North West Ethiopia: exploratory qualitative study.. BMC public health. https://doi.org/10.1186/s12889-025-23024-4