Sexual and Reproductive Health Service Utilization and Associated Factors Among Young People With Disabilities in Ethiopia: Systematic Review and Meta-analysis

Abstract

Disability is a major public health concern affecting about 16% of the global population. It results from the interaction of health condition and/or impairments with various contextual personal and environmental factors. All people need access to sexual and reproductive health (SRH) services, but young people with disabilities (YPWDs) need it even more. In Ethiopia, evidence indicates that YPWDs experience substantially limited access to SRH services. This study aimed to systematically identify, appraise, and summarize existing evidence on SRH service utilization and associated factors among YPWDs in Ethiopia. Eight electronic databases were searched for studies published between 2010 and 2024. Microsoft Excel and STATA software were used for data extraction and analysis, respectively. A random-effect model of meta-analysis was conducted. Heterogeneity was assessed using Cochrane’s Q and I² statistics and a funnel plot was used to identify whether there is a publication bias among included studies. Findings are reported according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Out of 2105 studies, 9 studies with 4066 YPWDs were included. The pooled prevalence of SRH service utilization among YPWDs in Ethiopia is 36.56% [95% CI: 29.58, 43.55], with P-value < .001 and I² = 95.76%. Good knowledge of SRH services was significantly associated with service uptake (OR 4.84, [1.16, 20.24], with P-value < .001 and I² = 87.3%). This study shows that SRH service utilization among YPWDs in Ethiopia remains low, with only 36.56% accessing the service. The significant association between knowledge of SRH and service uptake underscore the need for inclusive SRH strategies tailored to young people with disabilities through adapted communication and service delivery approaches.

Keywords

disability sexual and reproductive health service utilization young people with disabilities meta-analysis Ethiopia

Introduction

Disability is a major public health concern affecting about 16% of the global population.¹ It results from the interaction of a person’s health conditions and/or impairments (physical, sensory, mental, or cognitive) and various environmental and personal factors, which may limit, impair, interfere with, or affect an individual’s ability to perform routine activities and participate fully in the society.²

According to the World Health Organization, young people are defined as the age group 10 to 24 years, encompassing both adolescents and youth groups.³ There are around 315 million young people in Africa, representing 31.8% of the region’s total population, and that is estimated to account for 32.1% by 2030.⁴ Out of an estimated 180 million young people with disabilities globally; 144 million live in low income countries.⁵ Evidence from a national survey in Ethiopia indicates that an estimating 7.8 million people (9.3% of the total population) are living with some form of disability, of whom about 30% are children and young people under the age of 25.⁶ Additionally, estimates from the United Nations suggest a higher prevalence of disability (17.6%) in Ethiopia despite their under-representation in education, employment and healthcare.⁷

Sexual and reproductive health (SRH) service is a fundamental human right of all people and a basic aspect of public health. It encompasses a range of components that ensure individuals’ overall reproductive health and well-being.⁸ YPWDs have similar SRH rights and sexual desires as young people without disabilities. All people need access to quality SRH services, but YPWDs need it even more. Their SRH needs seem to be unique and account for special requirements. Identifying the specific SRH needs of YPWDs is crucial for creating effective health interventions tailored to their unique challenges.⁹

The enhancement of equitable access to SRH services can accelerate the accomplishment of the third goal of the UN 2030 agenda for sustainable development (SDG 3) by promoting the “leave no one behind” principle.¹⁰ Many countries have recognized the SRH rights of YPWDs and put in legislation irrespective of the enforcement differences across areas, leading to inequality of access among this segment of the population^10,11

Evidence in Ethiopia indicates a considerably limited access to SRH services for YPWDs,^12,13 along with the prevalent discrimination in the health care setting, exposing them to suffer from poor SRH outcomes, including STI/HIV, unintended pregnancy, cervical cancer, and unsafe abortion. The disability-unfriendly health facilities infrastructure and judgmental attitude of SRH service providers toward YPWDs underscores the need for reforming inclusive service provision.^14,15

Despite the considerable efforts made in Ethiopia, including the improvements made in health care infrastructure, training of health care providers, integrating SRH services, and the efforts made to raise public awareness,¹⁶ significant obstacles remain in place, shadowing the growing SRH service needs of YPWDs. Lack of adequate human and material resources, negative attitudes, residential disparity, and limited decision-making involvement of YPWDs restrict them from obtaining SRH services.^17-19

In Ethiopia, several studies have been conducted on SRH service utilization among YPWDs. Findings from those studies are characterized by significant variability and inconsistent results, ranging from the lowest prevalence of 17.2%¹² to the relatively highest proportion of 47.6%.²⁰ Moreover, research findings on this topic in Ethiopia are fragmented, published across different settings and study designs; lacking comprehensive empirical evidence. It is important to bridge the existing information and knowledge gap that prepare the ground to better understand the barriers and provide a solid policy foundation in ensuring disability-inclusive actions in the country. Therefore, using the available evidence, the current study aimed to determine SRH service utilization and associated factors among YPWDs in Ethiopia.

Methods

The current systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline,²¹ (see Figure 1). The search for existing body of literature was thoroughly conducted between January 01, 2010 and November 24, 2024 on SRH services utilization among YPWDs in Ethiopia.

Figure 1.

PRISMA flow chart depicting study selection process on SRH service utilization and associated factors among young people with disabilities in Ethiopia.

Registration

It is registered on PROSPERO with a unique registration number of CRD42024615478.

Eligibility Criteria

The population, intervention, comparison, and outcome (PICO±) study design filter framework was used to guide the inclusion/exclusion criteria and structuring of the research question in the current study. The CoCoPop (Condition, Context, and Population) and PEO (Population, Exposure, and Outcome) frameworks were used to decide on the inclusion of the prevalence studies and associated factors, respectively.²²

Inclusion Criteria

The review included all community and institution-based studies on the utilization of SRH services and associated factors among young people aged 10-24 years with any form of disability in Ethiopia. All English-language cross-sectional studies conducted in Ethiopia between 2010 and 2024 were included in the study.

Exclusion Criteria

We excluded articles published in languages other than English, case studies, secondary works (eg, review articles, commentaries, editorials, and unpublished conference abstracts), qualitative studies, and articles that have no relevant information associated with the current research question.

Search Strategy

Electronic databases, including Cochrane Library, Medline/PubMed, Scopus, Science Direct, Google Scholar, African Journals Online, the Ethiopian University online repository, and Google, were searched. The search was restricted by time and included all records between January 01, 2010 and November 24, 2024. References of included articles were also used to obtain additional studies related to the topic of interest. Some of the key terms and phrases used in the literature search were “SRH service” [MeSH Terms] OR “Contraceptive,” OR “maternal health services” “youth-friendly services” OR “Sexually transmitted infections” [MeSH Terms] AND “utilization” [MeSH Terms] OR “prevalence” OR “magnitude” AND “Young people” [MeSH Terms] OR “adolescents” OR “Youth” AND “disability*” [MeSH Terms] OR “impairment*” OR “deaf” [MeSH Terms] OR “blind” [MeSH terms] AND “Ethiopia” (see Supplemental File).

Related keywords and concepts, including contraceptive use, STI/HIV services, SRH counseling, modern contraceptive acceptance, and unmet SRH needs, were searched across the included databases; and finally references of the eligible studies were further checked for additional studies.

Study Selection

All the identified studies were imported into Medley Reference Manager, and duplicate records were removed.²³ Articles were assessed for inclusion by reviewing their title and abstracts, and if they fulfilled the inclusion criteria, a full review of the articles were considered for the final review and data extraction. Studies were screened based on the eligibility criteria independently by the 2 authors. The 2 authors disagreements were resolved through discussion referencing the pre-determined criteria. After the authors reached a consensus on the included articles, the final refined search results were compiled together.

Operational Definition

SRH services: refers to information and services on contraceptives, perinatal services, STI/HIV services, cervical cancer services, safe abortion services, GBV response services, sexual health education, menstrual hygiene education, and SRH-related harmful traditional practice prevention and management services.

SRH services Utilization: Utilization of at least one of the SRH services in the past 12 months.

Disability: involves a wide range of conditions, including physical, sensory, mental, or cognitive impairments that impair, interfere with, limit, or affect an individual’s ability to perform routine activities.²

Young People with disabilities: Population group age between 10 and 24 years who have any form of disabilities.⁴

Quality Assessment

The overall quality of the studies was assessed by 2 independent reviewers. The Joanna Briggs Institute (JBI) Meta-Analysis of Statistics Assessment and Review Instrument (MAStARI) for prevalence studies was used for critical appraisal.²⁴ The assessment tool contains 9 questions to decide on the methodological quality of studies.

A JBI score of “1” is provided for articles that fulfill the aforementioned parameters and “0” if not. When the available information is not adequate to make a judgment for that specific parameter, we grade that item a JBI score of “0.” Based on the total JBI score, each study was graded as good quality (7 or more fulfilled parameters), moderate (4 -6 fulfilled parameters), and low quality (with less than or equal to 3 fulfilled parameters). To consider inclusion, a total score of 70% (7 out of 9 questions) or more (low risk of bias) was considered, and all of the appraised studies found low risk²⁴ (see Supplemental Table 1).

Data Extraction

Data were extracted using MS Excel spreadsheet and pre-tested (n = 3) before the actual extraction. For each of the selected studies, data were extracted regarding the authors, publication year, study design, administrative region, study setting, sample size, proportion of SRH service utilization, level of risk bias, and significant factors associated with SRH service utilization among YPWDs. MT and TT extracted the required data independently, and together with the third reviewer (AA), data was checked for any discrepancies. Through discussion, the third reviewer made the decision.

Study Outcome

Pooled prevalence of SRH service utilization among YPWDs in Ethiopia.

Heterogeneity, Sensitivity and Publication Bias

Cochrane’s Q test and I² test statistics were used to assess heterogeneity. To declare heterogeneity, I² test statistics values of less than 25%, 25%-50%, 50%-75%, and >75% were considered as low, moderate, substantial, and considerable, respectively.²⁵ The REM was used to minimize the heterogeneity of included studies. Sub-group analysis was conducted based on different parameters to reduce random variation in the point estimates from the primary research. A sensitivity analysis was also conducted to identify the potential source of heterogeneity.

A visual inspection of a funnel plot was used to identify whether there is a publication bias among the included studies. To declare publication bias, Egger’s regression and Begg’s test were used, considering a P-value of less than .05. Sensitivity analysis was conducted using the random effect model (REM) to identify the influence of individual studies on the pooled estimate of SRH service utilization. A non-parametric trim and fill analysis was also conducted to deal with the publication bias.

Statistical Analysis

Data were extracted using Microsoft Excel and imported into STATA software version 17 for statistical analysis. REM in meta-analysis was conducted using the DerSimonian and Laird method²⁶ to obtain the Pooled Prevalence of SRH service utilization. Heterogeneity was assessed using the I² test, indicating a considerable heterogeneity among included studies.²⁵ Sub-group analysis was conducted on variables like publication year, sample size, and region. The findings of the study were reported in texts, tables, and graphs considering 95% CI and a P-value.

Results

Search Result

A total of 2105 records were generated from electronic databases, including Medline/PubMed (n = 1710), Cochrane Library (n = 60), African Journals Online (AJOL) (n = 196), Science Direct (n = 25), and other sources (n = 10). Google Scholar and Google websites were also searched for additional articles (n = 104). A sum of 1745 studies were identified as duplicates and removed. By reviewing the titles and abstracts, 322 studies were excluded. Five studies were not retrieved due to the inaccessibility of the full-text document. Finally, 33 full-text articles were retrieved, of which 9 articles^{12,13,15,18,20,27-30} met the review’s inclusion criteria and were included in the final analysis (see Figure 1).

Characteristics of Included Studies

A total of 4066 randomly selected study samples were involved in the included studies. All studies were conducted through a cross-sectional design. The sample size in the current meta-analysis ranges from the lowest 384²⁷ to the highest 557 participants.¹⁵ The number of included studies and participants was determined by the available published evidence that met the predefined inclusion criteria (see Table 1).

Table 1.

Characteristics of Included Studies in the Systematic Review and Meta-Analysis.

No.	Author, year	Publication year	Study setting	Study design	Sample size	Prevalence of SRH service use
1	Kassa et al, 2024(18)	2023	Addis Ababa	Cross-sectional	426	46.2
2	Mesfin Y., 2021(29)	2021	Arbaminch	Cross-sectional	422	40.5
3	Shehu EY, 2023(13)	2021	Dessie	Cross-sectional	423	42.0
4	Zeleke et al, 2024(15)	2024	Multiple regions	Cross-sectional	557	36.2
5	Alemu and Fentahun, 2011(27)	2011	Addis Ababa	Cross-sectional	384	33.3
6	Diribisa et al, 2022(12)	2022	Jimma	Cross-sectional	454	17.2
7	Kassa et al, 2014(20)	2014	Addis Ababa	Cross-sectional	426	47.6
8	Kassa et al, 2016(28)	2016	Addis Ababa	Cross-sectional	426	26.1
9	Meshesha et al, 2017 (Unpublished)	2017	Addis Ababa	Cross-sectional	548	40.52

Pooled Prevalence of SRH Service Utilization Among YPWDs in Ethiopia

The Pooled prevalence of SRH service utilization among YPWDs in Ethiopia is 36.56% [95% CI: 29.58, 43.55] with I² = 95.76% with P-value < .001. In this review, the lowest proportion of SRH service utilization (17.2%) was found in a study conducted at Jimma,¹² while the highest (47.60%) was reported from Addis Ababa.²⁰ The considerable heterogeneity obtained in the main meta-analysis led us to conduct a REM of meta-analysis using the DerSimonian and Laird method model²⁶ (see Figure 2).

Figure 2.

Forest Plot showing the Pooled prevalence of SRH service utilization among YPWDs in Ethiopia.

Assessing Heterogeneity

Considerable and significant heterogeneity was observed in the review using Cochrane’s Q test (P-value = .00 and I² = 95.76%). The Galbraith plot was also conducted using a REM, and visual inspection of the blue dots scattered sparsely around the regression line suggests the presence of heterogeneity among the studies, informing a notable variability in SRH service utilization by YPWDs across the included studies (see Figure 3).

Figure 3.

Galbraith Plot assessing heterogeneity among studies included in the systematic review and meta-analysis of SRH service utilization among YPWDs in Ethiopia.

Sub-Group Analysis by Region

Region-based sub-group analysis indicated that there is a significant and considerable heterogeneity among studies (I² = 95.76% with P-value < .001. The highest PP of SRH service utilization was found in the Amhara region at 41.96%, followed by South Ethiopia at 40.52%, AA at 38.71%, multiple regions at 36.2%, and the lowest proportion was from the Oromia region at 17.2%. There is a significant variation in SRH service utilization by YPWDs across different regions of the country (see Figure 4).

Figure 4.

Sub-group Analysis of SRH Service utilization among YPWDS in Ethiopia based on Region.

Sub-Group Analysis by Sample Size

A sub-group analysis based on the SS used in the primary studies revealed that there is a significant variation in the PP of SRH service utilization. in Ethiopia. For studies with sample size of less than the average 452 participants, the PP is 39.24% [95% CI: 32.41-46.07], compared to 31.27% [95% CI: 16.65-45.90] for studies with higher sample sizes (see Figure 5).

Figure 5.

Sub-group Analysis of SRH Service utilization among YPWDS in Ethiopia based on Sample Size Used.

Sub-Group Analysis by Year of Publication

Year of publication is further grouped into studies published before and after the median year 2021. A significant and high level of heterogeneity (I² = 97.04%) and (I² = 94.04%) with P-value < .001 was identified in studies conducted before 2021 (2011-2020) and after 2021 (2021-2024), respectively. Though the variation between the sub-groups, there is no significant difference in the outcome variable over time 36.85% (95% CI: 27.8-45.91) before 2021 and 36.35% (95% CI: 25.29-47.42) after 2021 (see Figure 6).

Figure 6.

Sub-group Analysis of SRH Service utilization among YPWDS in Ethiopia based on year of publication.

Sensitivity Analysis

A sensitivity analysis was conducted to identify the individual effect of every study on the overall PP of SRH service utilization. It is conducted by systematically excluding each primary study in the meta-analysis one at a time and re-estimating the overall ES. A relatively higher influence was obtained when removing Diribsa et al¹² and Meshesha,³⁰ while lower influence was observed when omitting Zeleke et al¹⁵ at P-value < .001 (see Supplemental Table 2). We can conclude that there are no studies in the review that substantially influenced the pooled prevalence of SRH service utilization (see Figure 7).

Figure 7.

Showing the effect of a single study on the Pooled Estimate of SRH service utilization among YPWDs in Ethiopia.

Publication Bias

In this study, publication bias was observed through the funnel plot. A visual inspection of the inverted asymmetrical funnel plot suggests a possible publication bias. Most of the effect size (ES) estimates, marked in red diamonds, are scattered at the bottom and inclined to the right side of the ES line, indicating a lower precision and possibility of publication bias, respectively (see Figure 8).

Figure 8.

Funnel Plot showing the existence of publication bias in the systematic review and meta-analysis.

Egger’s regression and Begg’s test for a small study effect were conducted and revealed the presence of a significant publication bias (P-value = .005 and P-value = .0286, respectively (see Table 2).

Table 2.

Illustrating Egger’s Regression Test.

Std_Eff	Coefficient	Std. err.	t	P > t	[95% conf. interval]
Slope	0.8711078	0.6612907	1.32	.229	−0.6925963	2.434812
Bias	1.20659	0.3015989	4.00	.005*	0.4934218	1.919758

Test of H0: No small study effects, P-value = .005.

To further assess the robustness of our findings and deal with publication bias, a non-parametric trim and fill analysis was conducted. This analysis resulted in a slight decrement in the adjusted OR of SRH service utilization, 34.92%, [95% CI: 33.491, 36.356] suggesting that some studies may be missing from the analysis, likely due to publication bias and conservatively emphasizing the importance of considering publication bias in meta-analytic interpretations (see Table 3).

Table 3.

Non-Parametric Trim and Fill Analysis of SRH Service Utilization Among YPWDs in Ethiopia.

Studies	Proportion (%)	[95% conf. interval]
Observed	34.924	33.491	36.356
Observed + Imputed	34.924	33.491	36.356

Factors Affecting SRH Service Utilization by YPWDs in Ethiopia

Knowledge of SRH services is significantly associated with SRH service utilization by YPWDs. On the other and factors like Sex (Being female), age of Participant (every additional year), educational status, forms of Disability, living status, having an open discussion on SRH issues, knowledge about SRH, favorable attitude on SRH, marital status), and history of sexual intercourse had no statistically significant association with SRH service utilization (see Table 4).

Table 4.

Factors Associated With SRH Service Utilization Among YPWDs in Ethiopia.

Variable	Author, year of publication	AOR	95% CI		Region
Variable	Author, year of publication	AOR	LCI	UCI	Region
Sex (Being female)	Kassa et al, 2023	5.4	2.4	12	Addis Ababa
Sex (Being female)	Kassa et al, 2016	2.2	1.2	3.8	Addis Ababa
Age of Participant (every additional year)	Kassa et al 2016	1.2	1	1.4	Addis Ababa
	Kassa et al, 2014	1.4	1.2	1.6	Addis Ababa
	Alemu and Fantahun, 2011	1.4	1.2	1.6	Addis Ababa
Educational status (literate)	Kassa et al 2023	3.1	1.2	7.9	Addis Ababa
	Diribsa et al, 2023	2.68	1.33	8.42	Oromia
	Alemu and fantahun, 2011	13.3	2.4	73.1	Addis Ababa
Forms of disability (Hearing impairment) Reference: Partial mental impairment, and visual impairment	Kassa et al, 2023	7	1.9	25.3	Addis Ababa
	Shehu EY et al, 2023	5	3.33	5.55	Amhara
	Alemu and Fantahun 2011	141.8	5.3	3803.5	Addis Ababa
	Zeleke et al, 2024	1.71	0.93	3.12	Multiple regions
Living status (Orphanage)	Kassa et al, 2023	4.5	1.2	17.1	Addis Ababa
	Shehu et al, 2023	3.6	1.36	9.35	Amhara
	Kassa et al, 2014	2.18	1.1	6.9	Addis Ababa
Having open SRH discussion	Mesfin Y., 2021	2.5	1.6	3.94	South Ethiopia
	Zeleke et al, 2024	3.84	2.596	5.689	Multiple regions
	Meshesha et al, 2017	3.59	1.6	7.9	Addis Ababa
Knowledge about SRH	Mesfin Y, 2021	1.9	1.21	3.09	South Ethiopia
	Zeleke et al, 2024	2.23	1.16	4.28	Multiple regions
	Diribsa et al, 2022	2.74	1.35	5.54	Oromia
	Shehu EY et al, 2023	0.1	0.01	0.61	Amhara
Favorable attitude on SRH services	Zeleke et al, 2024	2.87	1.94	4.23	Multiple regions
Favorable attitude on SRH services	Diribsa et al, 2022	5.34	2.05	13.92	Oromia
Marital status (Married) Reference: is unmarried/single	Kassa et al, 2014	2.7	1.5	4.8	Addis Ababa
Marital status (Married) Reference: is unmarried/single	Zeleke et al, 2024	5.5	2.64	11.46	Multiple regions
History of sexual intercourse	Meshesha et al, 2023	30.1	9.6	94.4	Addis Ababa
History of sexual intercourse	Diribisa et al, 2022	3.11	1.59	6.07	Oromia

Knowledge of SRH and Service Utilization

A pooled estimate of 4 studies^12,13,15,29 indicated that YPWDs with good knowledge of SRH services are more likely to utilize SRH services than those with poor knowledge OR = 4.84 [1.16, 20.24], with P-value < .001 and I² = 87.3% (see Figure 9).

Figure 9.

Pooled Odds ratio of the association between knowledge of SRH and SRH service utilization among YPWDs in Ethiopia.

Age of Participant and SRH Service Utilization

A pooled estimate of 3 studies^20,27,28 showed that the likelihood of SRH service utilization increased with age of participants (every additional year) OR = 3.74 [3.25, 4.31], and I² = 44.7% (see Figure 10).

Figure 10.

Pooled Odds ratio of the association between participant’s Age and SRH service utilization among YPWDs in Ethiopia.

Discussion

The analysis quantified that the pooled prevalence of SRH service utilization among YPWDs in Ethiopia is 36.56% [95% CI: 29.58, 43.55]. The overall Prevalence of SRH service utilization is comparable with studies conducted in South Africa,³¹ Lesotho,³² and Tanzania.³³ However, the finding is lower than other study findings as 61.9% in Nigeria,³⁴ 67.8% in Ghana,³⁵ and 55.9% in the USA.³⁶ Ethiopia’s deep socio-cultural norms surrounding sexuality and disability may contribute to poor open SRH communication with relatives and reduced service-seeking behavior among YPWDs.^19,28,37,38 It is also found to be higher than studies conducted in Kenya at 24.3%.³⁹ The observed cross-country variation in SRH service utilization among YPWDs may also result from the differences in socio-cultural characteristics, service accessibility, national policies, and differences in the advancement and quality of health care infrastructures.⁴⁰

Sub-group analysis on the Pooled Prevalence of SRH service varies by region, as the lowest prevalence of 17.2% [95% CI: 13.73-20.67] is identified in the Oromia region, while the highest prevalence of 41.96% [95% CI: 37.26-46.66] is in the Amhara region. The possible reason for the significant region-based variation might be the difference in socio-demographic and economic factors.⁴¹ This finding is in line with other similar studies conducted in the region on non-disabled adolescents and youths as only 21.2% and 23.5% of adolescents have utilized SRH services in the Nekemte and Haramaya districts of the Oromia region, respectively.^42,43 Additionally, inconsistencies in measuring tools, difference in operational definitions of key variables, and variation in disability category might cause the observed heterogeneity in our study.²⁵

The Pooled Prevalence of SRH service utilization varies with the sample size used in the primary studies. A higher PP 39.24% [95% CI: 32.41-46.07] is obtained on studies with a SS of less than 452 participants, and a slightly lower PP 31.27% [95% CI: 16.65-45.90] was found among studies with higher SS (>452 participants). The observed difference in the Pooled prevalence could be attributed to the fact that smaller sample sizes often lead to less reliable estimates that might mask the true picture of SRH service utilization among YPWDS.

A subgroup analysis based on the year of publication of studies indicated that a pooled SRH service utilization of 36.85% (95% CI: 27.8-45.91) and 36.35% (95% CI: 25.29-47.42) was found among studies published before and after 2021, respectively. A significant and high level of heterogeneity (I² = 94%, I² = 97%) with a P-value < .001 was identified within the group of studies published before and after 2021, respectively. Despite the variation within sub-groups, there is no significant difference in the outcome variable over time. This finding aligns with the fact that the realization of SRH services for YPWDs is still facing consistent denial/violation of SRH rights, leading to a persistent unmet need for SRH services over the years.^11,44,45

Consistent with the national and global health equity standards,^9,16 the current review emphasizes the underpinning of SRH service inequalities across different regions of Ethiopia. Evidence has realized that only 1/4th of PWDs in Sub-Saharan countries, including Ethiopia, are receiving SRH services, and it is bounded by many barriers.⁴⁶ The low SRH service utilization among YPWDs in Ethiopia underscores the need for targeted SRH education and improved community engagement, highlighting persistent gaps in enforcing the national adolescent and youth health strategy,⁴⁷ the national plan of action for persons with disabilities,⁴⁸ and the global accelerated action for the health of adolescents³ in the country.

Knowledge of SRH services is significantly associated with SRH service utilization. YPWDs who have good knowledge of SRH services have a 5-fold increased probability of utilizing SRH services than those with relatively poor knowledge of SRH services OR = 4.84 (P-value < .0001, I² = 87.3%). This result is consistent with previous findings⁴⁶; the possible reason might be that knowledge of SRH services enhances a better understanding of the common SRH problems and their prevention mechanisms, fostering open communication between sexual partners and enabling people to make informed decisions on their SRH needs.^49-51 The likelihood of SRH service utilization also increased with age (every additional year) OR 3.74, [3.25, 4.31] I² = 44.7%. Aligning with previous findings,³⁸ for every additional year, the odds of utilizing SRH service increased by 3.74 times compared with the previous year, suggesting a strong positive correlation between age and SRH service utilization among YPWDs in Ethiopia.

Strengths and Limitations

This study avoided duplication of effort by registering the study protocol of this relevant public health agenda. It revealed the current national evidence on the prevalence of SRH service utilization by YPWDs in Ethiopia and, therefore, will influence future SRH policy targeting age and disability-specific interventions to this population group. To avoid missing necessary evidence, the current review employed a comprehensive, double-blinded search approach conducted by 2 reviewers, consulting Cochrane’s Handbook for Systematic Reviews.⁵²

Despite adhering to the PRISMA guidelines,²¹ the findings of this study, however, should be considered along with its limitations. As this review did not conduct a formal sample size or power analysis, the statistical power of the pooled estimate depends on the number and size of the included studies. As all the included studies are observational, we might miss relevant qualitative and experimental studies in our review. The considerable heterogeneity in our findings may be attributed to the study setting as most of the included studies were conducted in Addis Ababa, the capital city of Ethiopia. This may limit the generalizability of findings to the rural areas of the country.

Conclusion

SRH service utilization among YPWDs in Ethiopia is considerably low. Considering the numerous barriers that YPWDs face in Ethiopia, it is evident that promoting SRH service is not merely a health care issue; it is also an important step toward safeguarding their rights, upholding their dignity, and ensuring equitable access to leave no one behind. Above all, YPWDs require age-specific SRH information and services that can accommodate their disability types and living situations. Therefore, policymakers should encourage the delivery of comprehensive and integrated service packages for this population segment in Ethiopia.

Supplemental Material

sj-docx-2-inq-10.1177_00469580261420715 – Supplemental material for Sexual and Reproductive Health Service Utilization and Associated Factors Among Young People With Disabilities in Ethiopia: Systematic Review and Meta-analysis

Supplemental material, sj-docx-2-inq-10.1177_00469580261420715 for Sexual and Reproductive Health Service Utilization and Associated Factors Among Young People With Disabilities in Ethiopia: Systematic Review and Meta-analysis by Mihiret Tesfaw, Takele Tadesse, Kassa Daka and Amene Abebe in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Supplemental Material

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Supplemental Material

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Supplemental material, sj-docx-4-inq-10.1177_00469580261420715 for Sexual and Reproductive Health Service Utilization and Associated Factors Among Young People With Disabilities in Ethiopia: Systematic Review and Meta-analysis by Mihiret Tesfaw, Takele Tadesse, Kassa Daka and Amene Abebe in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Supplemental Material

sj-pdf-1-inq-10.1177_00469580261420715 – Supplemental material for Sexual and Reproductive Health Service Utilization and Associated Factors Among Young People With Disabilities in Ethiopia: Systematic Review and Meta-analysis

Supplemental material, sj-pdf-1-inq-10.1177_00469580261420715 for Sexual and Reproductive Health Service Utilization and Associated Factors Among Young People With Disabilities in Ethiopia: Systematic Review and Meta-analysis by Mihiret Tesfaw, Takele Tadesse, Kassa Daka and Amene Abebe in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Footnotes

Acknowledgements

We thank all the authors of the primary studies included in this review.

Abbreviations

SRH, SRH; YPWDs, YPWDs, CI, Confidence Interval; PRISMA, Preferred Reporting Items for Systematic Review and Meta-analyses.

ORCID iD

Mihiret Tesfaw

Author Contributions

Conceptualization, M.T. and A.A., methodology, M.T., A.A., T.T., and K.D. Software, M.T., A.A.; formal analysis, M.T., A.A., T.T., and K.D.; writing—original draft preparation, M.T.; writing, review and editing, M.T., A.A., T.T., and K.D. All authors have read and agreed to the published version of the manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

All data for this study are presented in the manuscript and supplementary information.

Supplemental Material

Supplemental material for this article is available online.

References

World Health Organization. Global Report on Health Equity for Persons with Disabilities. World Health Organization; 2022. https://www.who.int/publications/i/item/9789240063600

World Health Organization. International Classification of Functioning, Disability and Health ICF. World Health Organization; 2001.

World Health Organization. Global Accelerated Action for the Health of Adolescents ( AA- HA !) Guidance to Support Country Implementation. 2nd ed. World Health Organization; 2023. https://iris.who.int/.Sales

World Health Organization. Regional Atlas on Adolescent and Youth 2017- Monitor the Health Status and Trend of Adolescent and Youth in Africa. World Health Organization; 2017.

Secretariat for the Convention on the Rights of Persons with Disabilities U and the BBI at SU. Fact Sheet: Youth with Disabilities. 2013. https://www.internationaldisabilityalliance.org/sites/default/files/ida-unfpa_briefing_note_online_youth_briefings.en_.pdf

UNICEF. MOLSA and Development Pathways. Situation and Access to Services of People with Disabilities and Homeless People in Two Sub-Cities of Addis Ababa. UNICEF; 2019. https://www.unicef.org/ethiopia/media/3016/file/3.Situationandaccess to services of persons with disabilities in Addis Ababa Briefing Note.pdf

United Nation Ethiopia. International Day of Persons with Disabilities marked with a call to accelerate efforts to ensure disability inclusion. December 3, 2024. Accessed February 10, 2025. https://ethiopia.un.org/en/286846-international-day-persons-disabilities-marked-call-accelerate-efforts-ensure-disability?

Gruskin

Yadav

Castellanos-Usigli

Khizanishvili

Kismödi

. Sexual health, sexual rights and sexual pleasure: meaningfully engaging the perfect triangle. Sex Reprod Heal Matters. 2019;27(1):29-40. doi:10.1080/26410397.2019.1593787

World Health Organization. WHO Recommendations on Adolescent Sexual and Reproductive Health and Rights. Licence: CC BY-NC-SA 3.0 IGO. World Health Organization; 2018.

10.

United Nation. Transforming the World: The 2030 Agenda for Sustainable Development. Vol A/RES/70/1. United Nation; 2022. doi:10.1007/978-3-031-07461-5_1

11.

UNFPA. Young Persons with Disabilities: Global Study on Ending Gender-Based Violence, and Realising Sexual and Reproductive Health and Rights. United Nations Population Fund; 2018. https://www.unfpa.org/sites/default/files/pub-pdf/Final_Global_Study_English_3_Oct.pdf

12.

Diribsa

Wakjira

Atomsa

, et al. Determinant factors of sexual and reproductive health service utilization among in-school adolescents with disability in Jimma Zone, Southwest Ethiopia. Int J Reprod Med. 2022;2022:1-9. doi:10.1155/2022/5945921

13.

Shehu

Kumar

Yimam

Anteneh

. Youths with disabilities: utilization and predictors of youths friendly reproductive health services in Dessie City Administration, North East Ethiopia, 2021: a cross-sectional study. Heal Sci Reports. 2023;6(7):1-7. doi:10.1002/hsr2.1386

14.

Alemu

. Assessment of Sexual and Reproductive Health Status and Related problems of young people with Disabilities in Selected Associations of people with disability, Addis Ababa, Ethiopia Advisor: Dr Mesganaw Fentahun. Published online 2008.

15.

Zeleke

Admas

Alemnew Chekole

, et al. Sexual and reproductive health services utilization and associated factors among disabled students in selected public universities of Ethiopia. Sex Disabil. 2024;42(1):67-83. doi:10.1007/s11195-023-09822-x

16.

Ministry of Health Ethiopia. At Workplaces Minimum Service Package for Adolescents and Youth Health at Workplaces in Ethiopia in Ethiopia. Ministry of Health Ethiopia. Published online 2022:49.

17.

MOH Ethiopia. Rehabilitation in Health System: Federal Democratic Republic of Ethiopia: Ministry of Health. December 2000.

18.

Kassa

Luck

Michel

Birru

Heller

SGR

. Sexual and reproductive health service utilization among young disabled people in Ethiopia: a cross-sectional study. Ethiop J Heal Biomed Sci. 2024;13(2):5-19. doi:10.20372/ejhbs.v13i2.450

19.

Ninsiima

Chiumia

Ndejjo

. Factors influencing access to and utilisation of youth-friendly sexual and reproductive health services in sub-Saharan Africa: a systematic review. Reprod Health. 2021;18(1):135. doi:10.1186/s12978-021-01183-y

20.

Kassa

Luck

Birru

Riedel-Heller

. Sexuality and sexual reproductive health of disabled young people in Ethiopia. Sex Transm Dis. 2014;41(10):583-588. doi:10.1097/OLQ.0000000000000182

21.

Liberati

Altman

Tetzlaff

, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100. doi:10.1371/journal.pmed.1000100

22.

Huang

Lin

Demner-Fushman

. Evaluation of PICO as a knowledge representation for clinical questions. AMIA Annu Symp Proc. 2006:359-363.

23.

Kusumaningsih

. Mendeley as A reference management and citation generator for academic articles. Proc Int Conf Appl Sci Eng. 2018;175:81-83. doi:10.2991/icase-18.2018.22

24.

Munn

Moola

Lisy

Riitano

. TCC 5. Systematic reviews of prevalence and incidence. In: A romataris

Munn

, eds. JBI Manual for Evidence Synthesis. JBI; 2020: 1-488.

25.

Higgins

JPT

Thompson

. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539-1558. doi:10.1002/sim.1186

26.

DerSimonian

Laird

. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177-188. doi:10.1016/0197-2456(86)90046-2

27.

Alemu

Fantahun

. Sexual and reproductive health status and related problems of young people with disabilities in selected associations of people with disability, Addis Ababa, Ethiopia. Ethiop Med J. 2011;49(2):97-108.

28.

Kassa

Luck

Bekele

Riedel-Heller

. Sexual and reproductive health of young people with disability in Ethiopia: a study on knowledge, attitude and practice: a cross-sectional study. Global Health. 2016;12(1):1-11. doi:10.1186/s12992-016-0142-3

29.

Mesfin

. Disparities in sexual and reproductive health service utilization and associated factors among adolescents with and without disability in Southern Ethiopia. Sci World J. 2021;2021:1-8. doi:10.1155/2021/5573687

30.

Meshesha

. Comparative Study on the Utilization of Reproductive Health Services and Factors Affecting It Among Students With and Without Disabilities in Public Universities in Addis Ababa. Addis Ababa University; 2017.

31.

Mathabela

Madiba

Modjadji

. Exploring barriers to accessing sexual and reproductive health services among adolescents and young people with physical disabilities in South Africa. Int J Environ Res Public Health. 2024;21(2):199. doi:10.3390/ijerph21020199

32.

Massetti

Stamatakis

Charania

, et al. Prevalence of functional disabilities and associations among disabilities, violence, and HIV among adolescents and young adults in Lesotho. J Epidemiol Glob Health. 2024;14(1):223-233. doi:10.1007/s44197-023-00184-3

33.

Mesiäislehto

Katsui

Sambaiga

. Disparities in accessing sexual and reproductive health services at the intersection of disability and female adolescence in Tanzania. Int J Environ Res Public Health. 2021;18(4):1-14. doi:10.3390/ijerph18041657

34.

Taiwo

. Access of in-school Young People with Diability to Sexuality Education in Osun State, Southwest Nigeria. Africa Regional Sexuality Resource Center (ARSRC); 2007.

35.

Kumi-Kyereme

. Sexual and reproductive health services utilisation amongst in-school young people with disabilities in Ghana. Afr J Disabil. 2021;10:671-679. doi:10.4102/AJOD.V10I0.671

36.

Graham

Holmes L

Shattuck

Nilssen

Strassberg

Himle

. Sexual and reproductive health service utilization and sexuality for teens on the autism spectrum. J Dev Behav Pediatr. 2020;41(9):667-679. doi:10.1097/DBP.0000000000000838

37.

Ganle

Baatiema

Quansah

Danso-Appiah

. Barriers facing persons with disability in accessing sexual and reproductive health services in sub-Saharan Africa: a systematic review. PLoS One. 2020;15:e0238585. doi:10.1371/journal.pone.0238585

38.

Delie

Adal

Tareke

, et al. Sexual and reproductive health service utilization and associated factors among high school students in Ethiopia: systematic review and meta-analysis. Front Reprod Heal. 2024;6: 1-12. doi:10.3389/frph.2024.1361662

39.

Kimani

Nyamari

Nyamu

. Factors that influence sexual reproductive health knowledge among adolescent girls with disabilities in Kiambu County. Afr J Midwifery Womens Health. 2024;18:1-7.

40.

WHO. Global Report on Health Equity for Persons with Disabilities. WHO; 2022.

41.

Zeleke

Zemedu

. Modern contraception utilization and associated factors among all women aged 15-49 in Ethiopia: evidence from the 2019 Ethiopian Mini Demographic and Health Survey. BMC Womens Health. 2023;23(1):51-57. doi:10.1186/s12905-023-02203-8

42.

Binu

Marama

Gerbaba

Sinaga

. Sexual and reproductive health services utilization and associated factors among secondary school students in Nekemte town, Ethiopia. Reprod Health. 2018;15(1):64. doi:10.1186/s12978-018-0501-z

43.

Abdurahman

Oljira

Hailu

Mengesha

. Sexual and reproductive health services utilization and associated factors among adolescents attending secondary schools. Reprod Health. 2022;19(1):161. doi:10.1186/s12978-022-01468-w

44.

Kwadwo Mprah

. Perceptions about barriers to sexual and reproductive health information and services among deaf people in Ghana. Asia Pacific Disabil Rehabil J. 2013;24(3):21-36. doi:10.5463/DCID.v24i3.234

45.

Habte

Dessu

. The uptake of key elements of sexual and reproductive health services and its predictors among rural adolescents in Southern Ethiopia, 2020: application of a Poisson regression analysis. Reprod Health. 2023;20(1):15. doi:10.1186/s12978-023-01562-7

46.

Tenaw

Gari

Bitew

Gebretsadik

. Contraceptive use among people with disabilities in sub-Sahara Africa: a systematic review and meta-analysis. J Public Health Res. 2023;12(4):22799036231204330. doi:10.1177/22799036231204330

47.

Ministry of Health Ethiopia. National Adolescents and Youth Health Strategy (2021-2025) Federal Democratic Republic of Ethiopia Ministry of Health. Ministry of Health Ethiopia; 2021.

48.

Ministry of Labour and Social Affairs Ethiopia. National Plan of Action of Persons With Disabilities (2012-2021). Ministry of Labour and Social Affairs Ethiopia; 2012. https://www.skillsforemployment.org/knowledge-product-detail/5230

49.

Tadesse

Dangisso

Abebo

. Sexual and reproductive health rights knowledge and reproductive health services utilization among rural reproductive age women in Aleta Wondo District, Sidama zone, Ethiopia: community based cross-sectional study. BMC Int Health Hum Rights. 2020;20(1):1-9. doi:10.1186/s12914-020-00223-1

50.

Lim

MSC

Zhang

Kennedy

, et al. Sexual and reproductive health knowledge, contraception uptake, and factors associated with unmet need for modern contraception among adolescent female sex workers in China. PLoS One. 2015;10(1):1-17. doi:10.1371/journal.pone.0115435

51.

Alemu

Assefa

. Reproductive health knowledge and services utilization among rural adolescents in east Gojjam zone, Ethiopia : a community-based cross-sectional study. BMC Health Serv Res. 2019;14(138):1-11.

52.

Higgins

JPT

Green

Ben Van Den

. Cochrane Handbook for Systematic Reviews of Interventions, Vol. 15. The Cochrane Collaboration; 2020.

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