Breaking Barriers: Challenges and Perspectives on Sexual and Reproductive Health Services for Ethiopian Sex Workers

Efforts by the Ethiopian government to provide sexual and reproductive health services to the country’s large youth population have been ongoing for the past two decades. However, coverage remains low, as indicated by the Ethiopian Demographic Health Survey, which found that a significant number of young women aged 15-19 have already become mothers or are pregnant with their first child, with 40% experiencing this by the age of 19. The barriers to accessing these services are multifaceted and include concerns about service quality and social norms that restrict young people’s decision-making abilities. Notably, social norms and cultural resistance have been identified as significant challenges in the implementation of sexual and reproductive health programs in Ethiopia.

Several studies have identified various obstacles that hinder access to sexual and reproductive health services. For example, in Rwanda, issues such as inadequate privacy, high costs of services, and inadequate facilities have been reported as barriers. Similarly, a study conducted in Nigeria found that individual, social, and health system factors were reported as impediments for adolescents seeking sexual and reproductive health information and services. A study in Ethiopia also revealed similar barriers, including poor attitudes of healthcare workers, distance to healthcare facilities, costly services, negative societal and cultural influences, and lack of privacy and confidentiality, all of which pose significant challenges to accessing sexual and reproductive health services and information (Sidamo et al., 2021).

The attitudes of healthcare providers are crucial in the delivery of sexual and reproductive health services. An unwelcoming environment and lack of respect towards youth can result in poor access to these services for young people. Moreover, marginalized groups such as sex workers, who are at increased risk of negative sexual and reproductive health outcomes, face heightened exclusion and abuse when seeking these services. Despite their urgent need for comprehensive care, they often encounter severe discrimination when seeking care at healthcare centers.

A sex worker who was a member of the Ethiopian youth panel disclosed that healthcare professionals at health centers often provide treatment out of obligation rather than genuine empathy. The participant highlighted that sex workers frequently face prolonged wait times before receiving care, and that healthcare workers do not offer them comprehensive or adequate treatment. Furthermore, the sex worker reported being told by healthcare providers that they are free to leave if they express dissatisfaction with the attitude of the healthcare providers, even before receiving any care.