How poverty prevents girls and young women accessing sexual health services

Research suggests the low economic status of adolescent girls and young women living in informal city settlements increases their risk of sexual violence and means they are unlikely to get justice. Poverty also means many cannot afford to access the sexual and reproductive health and rights (SRHR) services they need.

In 2019, 21 adolescent girls and young women (ages 14–23) living in the settlements of Kibwa and Kileku were interviewed. Ten decision-makers and 30 healthcare workers, teachers, parents, district leaders and community support officers were also interviewed.

Adolescent girls and young women knew about sexual rights, such as the idea of consent, but were unsure where to go if these rights were violated.

Most interviewees said poverty was helping to drive the ‘normalisation’ of sexual exploitation. They said families would arrange for their daughters to have sex or get married below the age consent in return for much-needed resources.

Their low economic status also meant adolescent girls and young women were at risk of sexual exploitation at school or when trying to get a job.

When sexual assault occurred, police corruption often prevented justice. This was also linked to money. Perpetrators of sexual violence with money received better treatment from the police and others and were often believed.

Many interviewees said that tackling police corruption would help adolescent girls and young women get justice for violations.

Interviewees said girls and young women who were sexually assaulted faced stigma, especially if they got pregnant. Those reporting violations were also open to abuse. This stops girls and young women from reporting violations to the police.

Sexual violence was often handled between families, but this left little support for the young women involved.

Poor treatment and stigma were the most common reasons adolescent girls and young women gave for not using SRHR services. Many said health staff mistreated them because they were young and had a low economic status.

Some girls and young women said staff would not provide sexual and reproductive health services if they came to a clinic without a husband.

Most participants said public health services lacked resources. People often have to pay for healthcare and medication. But many girls and young women cannot afford to do this so they turn to unregulated medicine.

Many interviewees said girls and young women did not use SRHR services because they were unaware of them or what they offered.

Adolescent girls and young women said they got information about SRHR from their peers and community-based organisations. Parents were not seen as useful information sources due to unsupportive attitudes.

Some interviewees said government restrictions on age stopped them from providing SRHR services to adolescent girls.

There is a need to address the causes of sexual violence and other SRHR violations. This may involve working with police, health professionals, community leaders and government officials to address corruption and make authority figures more accountable for rights violations. Working with boys, men and families to change attitudes and behaviours is also needed.

Economic empowerment schemes to address poverty may also be effective. Educating adolescent girls and young women on where to find SRHR services, including legal support, could also have an impact.