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 Original Article

Health providers’ perceptions of adolescent

sexual and reproductive health care
in Swaziland
P.T. Mngadi1,2 SRN/M, BEd Nursing, Dipl. Reproductive Health, MPH, PhD,
E. Faxelid3 PhD, I.T. Zwane4 SRN/M BSc Nursing, MPH, PhD, B. Höjer5,6 PhD &
A.-B. Ransjo-Arvidson3,7,8 PhD
1 PhD, 3 Associate Professor, 5 Professor, Division of International Health (IHCAR), 8 Associate Professor, Division of
Reproductive and Perinatal Health, Karolinska Institutet, Stockholm, 6 Professor, 7 Associate Professor, Högskolan Dalarna,
Falun, Sweden, 2 Head of Midwifery Department, 4 Dean, Faculty of Health Sciences, University of Swaziland, Mbabane,
Swaziland

MNGADI P.T., FAXELID E., ZWANE I.T., HÖJER B. & RANSJO-ARVIDSON A.-B. (2008) Health providers’
perceptions of adolescent sexual and reproductive health care in Swaziland. International Nursing Review 55,
148–155

Aim: To explore health providers’ perceptions of adolescent sexual and reproductive healthcare services
in Swaziland.
Methods: Fifty-six healthcare providers, working in 11 health clinics in Swaziland in 2005, were surveyed
using a semi-structured questionnaire. The data were analysed by descriptive statistics and content analysis to
identify key themes.
Findings: Most participants were women with a mean age of 36 years and a mean number of 6 years in the
profession. Services provided included STIs/HIV/AIDS advice, pre- and post-test counselling and testing on
HIV, contraceptives and condom use. Half of the nurses/midwives had no continued education and lacked
supervision on adolescent sexual and reproductive health care. The majority had unresolved moral doubts,
negative attitudes, values and ethical dilemmas towards abortion care between the law, which is against
abortion, and the reality of the adolescents’ situation. Forty-four wanted to be trained on post-abortion care
while eight on how to perform abortions. Twenty-six wanted the government to support adolescent-friendly
services and to train heathcare providers in adolescent sexual and reproductive health services.
Conclusion: The curricula within nursing and midwifery preservice education need to be reviewed to
incorporate comprehensive services for adolescents. There is need for provision of comprehensive services for
adolescents in Swaziland and appropriate youth-friendly services at all levels. There is need for nurse/
midwifery participation, advocacy and leadership in policy development.

Keywords: Adolescence, Health Providers, Midwives, Nurses, Nursing, Nursing Assistants, Perceptions,
Physicians, Sexual and Reproductive Health, Swaziland

Correspondence address: Dr Patricia T. Mngadi, Faculty of Health Sciences,
University of Swaziland, PO Box 369, Mbabane, Swaziland. Tel: 268-4040171/2;
Fax: 268-4046241; E-mail: thuli@realnet.co.sz.
Introduction
One-fifth of the world’s population consists of adolescents (10–
19 years old) and most of them (85%) live in low-income coun-
tries. During the transition from childhood to adulthood, young
people face considerable sexual and reproductive health (SRH)

© 2008 The Authors. Journal compilation © 2008 International Council of Nurses 148
Perceptions of adolescent sexual and reproductive health care
risks (WHO 2002). Adolescents as a group have SRH needs that
differ from those of adults. These needs are still poorly addressed
in most parts of the world. The International Conference on
Population and Development (ICPD 1994) stressed that adoles-
cents and young people have unique reproductive health services
(RH) needs that are distinct from those of adults. The ICPD
urged member states to address the information and adolescent
sexual and reproductive health (ASRH) services needs. The
ICPD also stressed that men and women are equal partners in
both SRH and rights aspects (UNFPA 2003).
Globally as many as 2.5 million unsafe abortions occur among
adolescents. This is a major cause of death among teenage girls
(WHO 2004). Furthermore, it is estimated that one of every 20
young persons worldwide contracts a sexually transmitted infec-
tion (STI) each year, and that the largest number of new cases of
STIs, including HIV, is in the 15–19 age group (Bankole et al.
2004; Jejeebhoy et al. 2002; WHO 2005). In a recent study con-
ducted in South Africa, it was found that one in five pregnant
adolescents was infected with HIV (Jewkes et al. 2001).
Despite these realities, which demonstrate adolescents’ acute
need for access to comprehensive sexuality education, informa-
tion and health services, resistance to provide young people with
SRH information and care continues in many countries. Adoles-
cent sexuality is still a sensitive issue among many health pro-
viders, parents and teachers. One major reason to the resistance
seems to be a common belief that information to the young
people promotes promiscuity. Studies have shown the contrary
that young people who are adequately informed postpone the
onset of their sexual activity, use contraceptives, have safer sex,
fewer partners and delay the first birth of a child (McCauley et al.
1995).
Adolescent sexual reproductive health
in Swaziland
In spite of all the global affirmations, RH services for adolescents
in Swaziland have been inadequately addressed and partly
neglected. The reasons for this are several. Health professionals
have been ill equipped to deal with adolescents’ needs, whether
for pregnancy prevention or when pregnancy arises. Swaziland
like most other countries in Southern Africa faces human
resource crises within the health sector. This problem has esca-
lated during the last decade owing to recruitment of nurses and
midwives to other countries, thus leaving a higher workload to
the remaining health professionals. The shortage of health staff is
further due to the serious HIV/AIDS situation. It is estimated
that 80% of bed occupancy in the medical and paediatric wards
is HIV/AIDS related (Kober & Van Damme 2006).
About one-third of the estimated 1.1 million population in
Swaziland is between 10 and 24 years old (CSO 1997). Half of the
© 2008 The Authors. Journal compilation © 2008 International Council of Nurses
149
adolescents do not complete 12 years of formal education, but
drop out of school owing to factors such as unplanned preg-
nancy, rural to urban migration, substance abuse, financial con-
straints and loss of parents owing to AIDS (SHAPE 2003). Sexual
debut is early (15 years for girls and 17 years for boys) and the
contraceptive prevalence rate among adolescent girls is as low as
10%. Unplanned or unwanted teenage pregnancies are common
and they account for 27% of the total number of pregnancies
(MOHSW 2001; SHAPE 2003). The HIV prevalence is 42.6% in
the general population and 29% among 15–19 years antenatal
care (ANC) attendants and 17% among boys 15–19 years old.
Sexual violence (rape, coercion) is prevalent, among school
going and other young women and it is common that young
women become pregnant as a result of this violence (SNAP
2005). Abortion is illegal in Swaziland and there is high preva-
lence of unsafe abortions among adolescents (MOHSW 2002).
Swaziland has a draft policy on SRH, which is waiting for
approval by the governing body.
Health providers within adolescent sexual and
reproductive health care
Registered nurses and midwives constitute the major workforce
within the SRH care services in Swaziland. They provide both
preventive and curative health care. Medical doctors receive their
education abroad as Swaziland has no medical school. Registered
nurses/midwives undergo 3-year state-regulated nursing educa-
tion and 1-year midwifery education. Registered assistant nurses
undergo 2 years of training and their professional role is mostly
restricted to clinical work. The curricula of nursing/midwifery
education in Swaziland as in other low-income countries are still
geared towards hospital-orientated medicine and less towards
public health orientation (Kwast & Bergström 2001). This has
important implications regarding primary healthcare preventive
aspects such as access to contraceptive services and prevention of
HIV/AIDS among the youth. As little attention has been paid to
adolescent SRH care services needs in Swaziland, this study was
carried out.
Aim
The aim of the study was to explore health providers’ perceptions
of ASRH care services in Swaziland.
Method
Study setting
The population of Swaziland is fairly evenly distributed across
the country, with Manzini and Hhohho regions having the
largest proportion of 30% and 28% respectively (CSO 1997). The
healthcare system in Swaziland comprises of public and private
150 P.T. Mngadi et al.
owned facilities. The service is highly subsidized in an effort to
place health care within the reach of everyone. About 80% of the
total population resides within 8 km radius of a health facility.
The health facilities are divided into three main levels: primary,
secondary and tertiary and decentralized into four administra-
tive regions (KOS 1999). In principle the health service provision
is free of charge at primary level but at secondary and third levels
the individual patients pay a small treatment fee. The primary
level health facilities consist of clinics and outreach sites.
Nurses, midwives and nursing assistants provide services at the
primary level.
This exploratory study was carried out in Mbabane, the capital
of Swaziland (in the southern part of the Hhohho region), and in
the northern part of the Manzini region between January and
March 2005. The facilities provide general services that focus on
environmental health, ANC, post-natal care, immunizations,
family planning, diarrhoeal diseases and respiratory tract infec-
tions to children, adolescents and adults. The adolescents visit
the clinics like any other clients in the community. In total there
were 11 primary health clinics that were in the study sites. There
were nine clinics in Mbabane [two mission clinics, two non-
governmental organizations (NGOs) clinics and five government
clinics]. There were two in Manzini (one mission clinic and one
government clinic).
Study population and sample size
Eligible to be included in the study were trained health providers
(physicians, midwives, nurses and nursing assistants) working
with SRH services in all the 11 healthcare facilities. All health
providers who were available in those healthcare facilities during
the study period were asked to participate in the study. Those
who consented were requested to complete a questionnaire with
regard to perceptions of adolescent SRH care services.
According to the Ministry of Health and Social Welfare staff
register, the study sites were supposed to have a total of 100 posts
for health providers. However, owing to migration of health
providers from Swaziland to other countries for better salaries or
to study, only 75 posts were filled. Of those eight midwives had
gone on study leave, four health providers had gone on other
forms of leave and five had gone to assist with healthcare service
(relief) in other facilities. Thus, a total of 58 health providers
remained and were given the questionnaire to complete.
Data collection
The questionnaire was in English, which is the official language
in Swaziland and was designed by the first author. Prior to the
main study, a pilot study was carried out with seven health
professionals. The questionnaire included questions about socio-
demographic issues and different sections. These sections were:
© 2008 The Authors. Journal compilation © 2008 International Council of Nurses
services provided to unpregnant adolescents, pregnant adoles-
cents, adolescent mothers and adolescent boys; emergency con-
traceptives; aspects of abortion care; problems related to service
provision; training and supervision related to ASRH services;
guidelines and educational materials; and suggested ways on how
to improve the ASRH care services.
Each questionnaire was sealed in a separate envelope to be
distributed and collected by the nurses-in-charge. To remain
anonymous, no names were marked on the questionnaires. The
nurse in-charge reminded the participants at least twice, to hand
in the completed questionnaires. The definition of ASRH ser-
vices was explained in the questionnaire and included all aspects
of RH issues including abortion care.
Data processing and analysis
The data were analysed by descriptive statistics and content
analysis to identify key themes.
Ethical consideration
Written consent was received from the administrators at the 11
health facilities. The respondents received written information
about the study and that participation was voluntary. Partici-
pants were also assured that information obtained would be
treated with confidentiality. The Research and Ethics committees
at the Swaziland Ministry of Health and Social Welfare granted
approval for the study.
Findings
Background data of the participants
Out of 100 established health providers’ posts only 58 were cur-
rently filled, demonstrating a staff shortage. Of those 58, all but
two health providers (physicians) answered the questionnaire
giving a response rate of 56 (97%). The reason why two physi-
cians did not answer the questionnaire is not known. The major-
ity of the respondents were women. Their age ranged between
22 and 52 years (mean 36). A total of 68% were Christians and
out of these, 18% were Roman Catholics. Seven per cent were
Muslims and the rest did not answer the question. The mean
number of working years was 6 (range = 1–21 years). For further
information see Table 1. The findings are presented in different
sections.
Services provided
On the question: ‘Do adolescent clients come to the clinic where
you are working?’ Almost all the respondents 54 (96%) answered
that both girls and boys came to the facilities for SRH services.
The most common services provided concerned the adolescent’s
requests for contraceptive advice. Forty-four (78%) respondents
Perceptions of adolescent sexual and reproductive health care 151

Table 1 Background characteristic of participants (n = 56) Table 2 Healthcare services offered to non-pregnant girls by healthcare
providers (n = 56)

n (%)
n (%)
Sex
Male 7 (13) STI/HIV counselling 12 (22)
Female 45 (80) Contraceptives 13 (23)
Missing items 4 (7) Advice on pregnancy prevention 4 (7)
Total 56 (100) Condom provision 2 (4)
Age range (years) Treatment of STIs 4 (7)
20–29 14 (25)
30–39 27 (48)
40–49 13 (23) STI, sexually transmitted infection.
50–60 2 (4)
Total 56 (100)
Marital status (checking of weight, blood pressure measurement, syphilis test,
Single 23 (41) immunizations and prescription of iron tablets). Furthermore,
Married 30 (53)
three (5%) answered that they offered voluntary counselling and
Widowed 1 (2)
Divorced/separated 1 (2) testing for HIV.
Missing item 1 (2)
Total 56 (100) Health services offered to adolescent mothers
Number of children
0 19 (34)
The main advice given to adolescent mothers was related to
1–2 31 (55) post-partum care for the mothers and their babies by 32 (57%)
3 and above 6 (11) of the respondents. Further, 12 (21%) mentioned that they gave
Total 56 (100) advice about contraceptives. Only three (5%) mentioned that
they advised the adolescent mothers on immunization of the
babies. None of the respondents specifically answered that they
answered that they provided contraceptives to the adolescents advised adolescent mothers on breast-feeding.
when they asked for them and when they were available. Those
who did not provide contraceptive services answered that con- Health services offered to adolescent boys
traceptive use was against their religion and that youth should Twenty (36%) respondents answered that they told boys to use
not indulge in sex. condoms during sexual intercourse. Nine (16%) said that they
Twenty-one (38%) of the respondents discussed topics such as gave boys advice on STIs/HIV counselling and testing. Only one
STIs, HIV/AIDS with adolescents. Nineteen (34%) respondents health staff discussed masturbation with boys.
mentioned that they gave pre- and post-test HIV counselling
talks. A few mentioned that they discussed growing up, love Emergency contraceptives
relations, sexual intercourse, parenthood and treatment of minor In response to the question ‘Do you offer any emergency contra-
ailments, e.g. common cold. They also counselled both boys and ceptives after an adolescent has been raped?’, 27 (48%) wrote that
girls on individual social problems. Some of the questions they offered emergency contraceptives, but only if the girl was
focused on what special health services were offered to different brought by the police, as a reported police case. Six (36%) of the
adolescent groups such as the non-pregnant girls, pregnant girls, 19 who did not offer the service answered that they had never
adolescent mothers and boys. come across any such case. Three nursing assistants wrote that
they had not been trained in emergency contraception. One
Health services offered to non-pregnant adolescent girls respondent mentioned that the emergency contraceptive pill was
The most frequent health services offered to non-pregnant ado- not available at the unit where she was working.
lescents were contraceptive services and STIs/HIV counselling
and testing (see Table 2). Aspects of abortion care
When the health providers were asked, ‘How would you respond
Health services offered to pregnant adolescents or react if an adolescent girl requested for an induced abortion?’,
Regarding health services provided to pregnant adolescents, 17 (30%) wrote that they would not agree to assist in performing
30 (54%) respondents answered that they offered routine ANC the procedure at all. Instead, they would counsel the girl on the

© 2008 The Authors. Journal compilation © 2008 International Council of Nurses

152 P.T. Mngadi et al.
dangers of an abortion, but still refer her to an institution that
performs abortions (though it is illegal). Sixteen (29%) answered
that they would explain the advantages and disadvantages of an
abortion. Five (9%) nurses and midwives wrote that they would
tell the girl that the Swazi law forbids abortion. Three (5%)
answered that they would chase the girl away from the facility
and 13 (23%) did not answer the question.
Problems related to provision of contraceptive services
The majority of the health providers stated problems that they
encountered at their facilities regarding service provision.
Twenty-six (46%) stated that they had no contraceptives in stock
at the health facility. Fifteen (27%) mentioned that adolescents
were reluctant to come for contraceptive services and another 15
(27%) mentioned that their religious beliefs and personal values
did not allow them to provide contraceptives. Five (9%) respon-
dents wrote that they did not provide contraceptives because of
the institution’s principles (Roman Catholic clinic).
In response to the question, ‘Would you personally provide
family planning services to your own adolescent daughter if she
was sexually active?’, 47 (84%) wrote that they would. Nine
(16%) wrote that they would not as illustrated by the following
quotes: ‘If possible I would like my daughter to abstain from
sexual activity.’ Another one wrote ‘I would openly explain the
risks that are involved in having sexual relations while still young
and not being married.’
Training and supervision related to adolescent sexual and
reproductive health services
Regarding training and supervision in adolescent SRH services,
31 (55%) respondents answered that they had never received any
special training in relation to adolescents’ SRH needs. Twenty-
four (43%) respondents (seven physicians, 17 nurses and mid-
wives) stated that they had received training during their basic
medical, nursing and midwifery education. However, all respon-
dents stated that they needed more knowledge about adoles-
cents’ SRH service needs.
Further, with regard to the kind of training they would need in
order to perform good services to adolescents, 44 (79%) wanted
to be trained in post-abortion care. Eight (14%) wanted to be
trained on how to support an adolescent having an unplanned
pregnancy. Twenty (36%) wrote that they had been trained on
emergency contraceptives. With regard to supervision, 28 (50%)
respondents (12 nursing assistants, 16 nurses and midwives)
wrote that there was no supervision at all in relation to ASRH
services provision.
Guidelines and educational materials
In regard to availability of guidelines and educational materials
(IEC) in relation to ASRH care services, 45 (80%) respondents
© 2008 The Authors. Journal compilation © 2008 International Council of Nurses
Table 3 Healthcare providers’ suggested ways of improving adolescent
sexual and reproductive health (ASRH) care (n = 56)
Suggestion n (%)
Youth-friendly services 26 (46)
Comprehensive training in ASRH and STI/HIV/AIDS for 10 (18)
healthcare providers
Strategies rooted in positive Swazi culture 7 (13)
Understanding and support from the highest authority 7 (13)
Formation of youth clubs 6 (10)
Total 56 (100)
STI, sexually transmitted infection.
answered that they did not have guidelines on how to provide
ASRH services and nine (16%) answered that they had guide-
lines but never used them. Seven (13%) respondents wrote that
they had educational materials; however, some expressed a
concern that very few copies were produced and that the material
was not age specific.
Twenty-six (46%) of the respondents wrote that the informa-
tion to adolescents had to be improved. They also mentioned
that more SRH information materials were needed for the young
people. Furthermore, some of the respondents wrote that they
did not know where and how to get the material, and others
mentioned that they had no time to go to the Ministry of Health
to ask for IEC material. A few wrote that there was no space in the
facility where they could display the IEC material.
Suggested ways to improve adolescent sexual and reproductive
health-care services
Twenty-six (46%) respondents wrote that the Swaziland Govern-
ment should be more involved in promoting and supporting
adolescent-friendly services as a means to improve adolescents’
health. Training of health providers in comprehensive ASRH was
also mentioned as a way to improve the services. Last, they men-
tioned that IEC materials to young people are needed and addi-
tional suggestions from the respondents are presented in Table 3.
Discussion
In this study we have investigated the health providers’ percep-
tions of ASRH care services. Four main aspects from the findings
will be discussed:
1 service needs,
2 problems related to service provision and aspects of abortion
care,
3 training, supervision, guidelines and education materials
related to ASRH care services, and
4 suggested ways of improving ASRH care services.
Perceptions of adolescent sexual and reproductive health care
Service needs
The majority of the participants answered that both adolescent
girls and boys came to their facilities for SRH care services. The
most common services that were provided were advice on con-
traceptive use and on voluntary counselling and testing of STIs/
HIV/AIDS. However, only one-fifth answered that they discussed
contraceptive use/FP with non-pregnant adolescent girls and
counselled them on STIs and HIV/AIDS and a few gave advice on
condom use. This finding is in line with a report from a recent
survey carried out in Swaziland with the aim to investigate school
youth 13–19 years old on knowledge and practice related to
sexuality. Although 47% reported that they used condoms
during their last sexual intercourse, they also pointed out that
nurses’ negative attitudes towards young people obtaining
condoms at clinics were a major hindrance (SHAPE 2003).
Furthermore, in a community-based study on cultural and
gender issues related to HIV/AIDS prevention in rural Swazi-
land, people had heard of condoms, but few had actually used
them. They heard many negative aspects about condoms includ-
ing reduced sensation, ease of rupture, unavailability and lack of
access to condoms (Buseh et al. 2002a). With known evidence
that condoms have double protective effect, preventing
unplanned pregnancies and preventing the spread of STIs and
HIV/AIDS, every commitment should be to fully implement the
declaration of commitment of HIV/AIDS ‘Global Crisis-Global
Action’ (UN 2006).
In another study from Swaziland, 42% adolescents mentioned
that they preferred information from healthcare workers about
HIV/AIDS and sexual risk behaviour information. However,
only 10% had received information from health workers (Buseh
et al. 2002b). Health providers thus seem to need training in
comprehensive ASRH care services to enable them to deliver
quality care in a holistic approach.
Problems related to service provision and aspects of
abortion care
The results reveal that not all adolescents were provided with the
services they needed, particularly contraceptives. The reasons for
this were that there were no contraceptives in stock owing to
institutional principles and that some health providers did not
agree with providing contraceptives to them.
Health providers, who are in charge of providing ASRH ser-
vices, seem to have unresolved moral doubts towards some RH
services like contraceptives and abortion. In such situations,
nurses and midwives are commonly confronted with ethical
dilemmas (Botes 2000). The issue of unavailability of contracep-
tives and negative attitudes towards abortion in some institu-
tions is a dilemma between reality, norms and adolescent needs
that nurses and midwives face in Swaziland. Studies in South
© 2008 The Authors. Journal compilation © 2008 International Council of Nurses
153
Africa, Zambia and Kenya have shown that health providers are
insensitive to women who terminate unwanted pregnancies
(Jewkes et al. 1998; Koster-Oyekan 1998; Rogo et al. 1998).
Similar to our findings, Koster-Oyekan (1998) in Zambia and
Rogo et al. (1998) in Kenya found that health providers strongly
opposed abortion for ethical and religious reasons.
The majority of the midwives and nurses in the present study
answered that they did not want to be trained on how to perform
an abortion, as abortion is not allowed in Swaziland; however,
they would counsel the adolescent girl and explain the advan-
tages and disadvantages of the procedure. They would also refer
her to certain NGOs and private practitioners that perform the
procedure.
Stressing the dangers of abortion rather than supporting
clients to make what they think is a rational choice is a problem.
This may reflect that health providers especially nurses and mid-
wives within the SRH area are at a critical intersection between
values and norms of the community which advocates sexual
abstinence before marriage and the reality of adolescents engag-
ing in premarital sex. The messages to clients may be contradic-
tory. This dilemma has been illustrated from settings like
Vietnam, Kenya and Zambia, whereby it is recommended that
midwifery education should encourage value-reflective thinking
around gender inequality and ethical dilemmas, in order to
prepare nurses and midwives to address adolescents’ RH needs
(Klingberg-Allvin et al. 2006; Warenius et al. 2006).
Studies from South Africa (Tjallinks 1989) and Zambia
(Warenius et al. 2006) have also shown that nurses’ attitudes
towards abortion were either judgemental or conservative. It has
been suggested that ‘value clarification training’ might be helpful
in reducing negative attitudes towards abortion among health
providers. The training helped the participants to reflect on their
feelings and thoughts about abortion and encourage a non-
judgemental approach to service provision. Such an approach
emphasizes on treating young women with dignity and respect
regardless of the providers’ views and values (Klingberg-Allvin
et al. 2006).
Most respondents in this study were ambivalent for moral/
value reasons. Their situation was also complicated by the ille-
gality of the abortion procedure. Therefore, more qualitative or
observational research is needed to examine abortion-related
attitudes and care.
Training, supervision, guidelines and educational materials
related to adolescent sexual and reproductive healthcare services
The lack of training, supervision, guidelines and education
materials, which was expressed by the nurses and midwives, is of
great concern. Most of the participants reported that they never
received training on ASRH. Half of the respondents answered
154 P.T. Mngadi et al.
that there was no supervision conducted at their facilities. Yet,
clinical supervision is widely accepted as an essential prerequisite
for high quality of maternity care (Edwards et al. 2005). Clinical
supervision is a formal support and learning, which enables indi-
vidual health providers to develop knowledge and competence,
assume responsibility for their practice and enhance consumer
protection and safety of care in complex clinical situations. If the
training and supervision can be improved, the organization
and provision of nursing and midwifery services can also be
improved.
However, the lack of training, supervision, guidelines and edu-
cation materials might not be the only factor that results in poor
ASRH care services. The serious shortages of workforce in the
health sector, owing to emigration, attrition to HIV/AIDS and
the lack of political commitment to support the nursing and
midwifery education institutions as indicated in a recent study
conducted in Swaziland (Kober & Van Damme 2006), contribute
to the poor services. It is very important to plan, prepare and
maintain quality of healthcare workers required by the health-
care system (WHO 2006).
Suggested ways of improving adolescent sexual
and reproductive healthcare services
There is demand from the health providers that comprehensive
ASRH and services should be given a prominent place in the
political agenda. The majority of health providers suggested that
the policy makers should be involved in promoting and support-
ing specific adolescent-friendly environment so as to improve the
quality of ASRH services in Swaziland.
The need for re-orienting and allocation of resources for
health, recruiting more people to medical, nursing and mid-
wifery schools and upgrading their training and skills are
obvious strategies to meet the growing demand for quality care
services. These will address the lack of essential services (Berer
2006) especially for adolescents and young people.
Limitations of the study
Our study had limitations. The participants were drawn from a
convenience sample in two regions of Swaziland and in 11
healthcare facilities. The sample was compromised because it
consisted only of health providers who were available during the
study period. Hence, it excluded those who were on leave, on
relief duty at other stations, had migrated to other countries for
greener pastures and those who were on study leave. There is,
however, no reason to suspect the selection excluded staff
members with different opinions. Although the sample size is
small, the results highlight health providers’ perceptions of
ASRH services in Swaziland. It is important that future studies
should consider also the adolescent perceptions of health pro-
© 2008 The Authors. Journal compilation © 2008 International Council of Nurses
viders working with ASRH services issues for a broader picture of
the actual situation in Swaziland.
Conclusion
Most health staff acknowledged that they were not adequately
equipped with knowledge and skills to provide high-quality and
comprehensive ASRH care services. More attention should be
paid to providing systemic training of clinical health staff in
comprehensive ASRH care services. The curricula within nursing
and midwifery preservice education also need to be revised to
prepare health providers to address and deal with adolescents’
healthcare needs. There is a need for accessible, appropriate,
youth-friendly SRH services that are supported at all levels.
There is a need for nurse/midwifery participation, advocacy and
leadership in policy development, which is important for policy
change. The findings of this study will contribute to increased
knowledge and literature regarding this important topic.
Implications of findings
Sexual and reproductive health and rights
The research adds to the available evidence-based findings for
the need to integrate comprehensive ASRH and abortion care to
the reproductive health and rights programme in Swaziland. It
also highlights current inadequate access to appropriate SRH
services for adolescents in Swaziland.
Health providers
There is a need for healthcare providers to acquire training on
comprehensive ASRH including abortion care. The curricula
within nursing and midwifery preservice education need to be
revised. Health providers’ attitudes, counselling and communi-
cation skills in relation to ASRH need to be improved. Value
clarification and reflective training for health providers would
enable them to deal with issues related to SRH with adolescents
appropriately. Youth-friendly services are needed at all levels.
Policy makers
Improving the ASRH in Swaziland requires a multisectoral
response as it has broader implications beyond the healthcare
system. Support and commitment from all policy makers in the
different sectors are required to achieve in the improvement of
the ASRH services in Swaziland.
Acknowledgements
We gratefully acknowledge the helpful participation of the health
providers regardless of their busy schedules and the Swedish
Institute. Without their contribution the study would have not
been completed.
Perceptions of adolescent sexual and reproductive health care
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