Utilization of Sexual and Reproductive Health Services in Ethiopia – Does it affect sexual activity among high school students? Selamawit M. Bilal a, *, Mark Spigt b , Geert Jan Dinant b , Roman Blanco c a Department of Public Health, University of Mekelle, P.O.Box:1871, Mekelle, Ethiopia b Department of Family Medicine, CAPHRI, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands c Department of Surgery, University of Alcala, Alcala, Madrid, Spain ARTICLE INFO Article history: Received 16 July 2013 Revised 23 September 2014 Accepted 30 September 2014 Keywords: Sexual and reproductive health service Sexual activity Parental monitoring Parent–child communication A B ST R AC T Objective: Universal access to Sexual and Reproductive Health (SRH) services for adolescents was added as a target to the revised Millennium Development Goals framework in 2005. However, the utilization of SRH services among adolescents and their sexual activity is not well explored in Ethiopia, with the result that there is no well-designed and sustainable school based intervention for high school stu- dents. We aimed to investigate the utilization of sexual and reproductive health services and sexual activity and, to provide evidence based information and recommendations for possible interventions. Study design: A cross-sectional survey was conducted among 1031 female and male high school stu- dents aged 14–19 years in Mekelle town, Tigray Region, North Ethiopia. A total of 1031 students participated. Self-administered questionnaire was used. Main outcome measures: Utilization of sexual and reproductive health services and sexual activity were investigated using a self-administered questionnaire. Results: One out of five students had used the SRH services in the past year. The primary reason for vis- iting the SRH services was to receive information. The mean age for the first sexual intercourse was 15.7 and one-quarter of the students had multiple sexual partners. Unwanted pregnancies and abortions were reported by female students. Conclusion: SRH services are known and used by students. However, sexual activity at an early age among high school students and unwanted pregnancies and abortions among female students still call for at- tention. Therefore, providing accurate SRH information on safe sex and enhancing family–student discussion could be a good approach to reach SRH of adolescents. © 2014 Elsevier B.V. All rights reserved. Introduction Today’s generation of adolescents is the largest in history and more than three fourth of this population lives in developing nations [1,2]. Especially, Sub-Saharan African countries have a larger pro- portion of adolescents than any region in the world [3]. Ethiopia, located in Sub-Saharan Africa, shows a steady increase in its ado- lescent population [4]. Adolescents are the greatest hope for turning the tide against sexually transmitted infections (STI), Acquired Immune Deficiency Syndrome (AIDS) and early pregnancy [5]. However, lack of accurate information about reproductive health and sexuality and lack of access to reproductive health services put adolescents at higher risk, particularly in developing countries [6]. For instance, early sexual initiation [4,7] is very common and adolescent pregnancy remains high globally, with 52 births for every 1000 girls aged 15–19 years in 2007, especially in Sub-Saharan Africa which has the highest rate [8,9]. Having multiple sexual partners was also reported to be very common in Nigeria [7]. Globally, a number of strategies have been adopted. Univer- sal access to Sexual and Reproductive Health (SRH) services for adolescents was added as a target to the revised Millennium De- velopment Goals framework in 2005 [10]. As a result, there is growing recognition of the importance of addressing the sexual and reproductive health of adolescents [11]. Different SRH programs have been initiated at community and school levels in order to reach ado- lescents. For instance, a school based intervention in Tanzania and India has proven successful in addressing the knowledge of stu- dents on sexual and reproductive health [12,13]. Similarly, in Nigeria, a curriculum designed to provide comprehensive health educa- tion for urban high school students resulted in delayed initiation of sexual intercourse, reduced number of sexual partners and in- creased use of condoms [14]. In Ethiopia, a total of 27 youth friendly services throughout the country were implemented [15]. These * Corresponding author. Department of Public Health, University of Mekelle, P.O.Box:1871, Mekelle, Ethiopia. Tel.: +251 0913185831. E-mail address: selamhunu@gmail.com (S.M. Bilal). http://dx.doi.org/10.1016/j.srhc.2014.09.009 1877-5756/© 2014 Elsevier B.V. All rights reserved. Sexual & Reproductive Healthcare 6 (2015) 14–18 Contents lists available at ScienceDirect Sexual & Reproductive Healthcare journal homepage: www.srhcjournal.org