Sexual and reproductive health service utilization and associated factors among in-school female adolescents in the Harari region, Eastern Ethiopia: A mixed-methods study.

Adolescents, especially females, are vulnerable to a wide range of sexual and reproductive health problems, including early marriage, unintended pregnancy, unsafe abortion, and sexually transmitted infections, including HIV/AIDS. Despite the increased vulnerability, they often have limited access to sexual and reproductive health services that focus on the special needs of female adolescents. This study aimed to assess sexual and reproductive health service utilization and its associated factors among in-school female adolescents in the Harari Region, Eastern Ethiopia. Methods: A school-based mixed-method cross-sectional study was conducted among female adolescents aged 15-19 years. A total of 456 participants were selected using a simple random sampling technique from eight randomly selected secondary schools, of whom 446 provided complete data. For the qualitative study, 10 participants were purposively selected for interviews. Quantitative data were collected using a structured, pretested, self-administered questionnaire and analyzed with SPSS version 26 after entry into EpiData version 4.6. Bivariable and multivariable logistic regression analyses were performed, with significance set at p < 0.05. Qualitative data were collected using in-depth interviews, analyzed thematically, and integrated with quantitative findings. Results: A total of 446 completed the survey questionnaire, constituting a response rate of 97.8% (446/456). Among those who completed the survey, 27.8% (95% CI: 23.8-32.1) utilized SRH services. Being in grades 11-12 (AOR = 2.17, 95% CI: 1.29-3.63), not living with family (AOR = 4.36, 95% CI: 2.63-7.27), participation in school clubs (AOR = 4.47, 95% CI: 2.68-7.45), exposure to SRH information (AOR = 2.54, 95% CI: 1.39-4.62), and awareness of SRH service-providing facilities (AOR = 2.23, 95% CI: 1.31-3.77) were significantly associated with the utilization of SRH services. Qualitative findings revealed key barriers such as limited awareness, inconvenient service hours, cultural taboos, parental control, and concerns about privacy. Conclusion: Sexual and reproductive health services utilization among female students in the Harari Region was suboptimal (27.8%). Health facilities and schools should work coordinately to enhance the utilization of sexual and reproductive health services among adolescents.