Addressing Provider Bias for Better Youth Healthcare

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Metrics for Management and EngenderHealth work to improve health systems and services so individuals can choose and access the healthcare they need. Metrics for Management (M4M) focuses on developing and advocating for practical measurement indicators and tools to improve the quality of health services. EngenderHealth is committed to advancing sexual and reproductive health rights and gender equality by collaborating with communities, civil society organizations, and governments to ensure access to high-quality services and a supportive policy environment. 

Despite global commitments, young people often have sexual and reproductive health needs that go unmet, with M4M’s research uncovering inadequate privacy, confidentiality, and provider bias as key drivers for young people’s unmet need. In this article, we closely examine the issue of provider bias, a paramount concern for young people. EngenderHealth believes in working with, not just for, young people—and that means addressing the issues that concern them most.

Why We Measure and How

At M4M, we believe innovative measurements for adolescent and youth sexual and reproductive health (AYSRH) service quality are essential to increasing access to high-quality sexual and reproductive (SRH) services. Our work has consistently shown that effective, sustainable quality improvement is most likely to occur when measures are streamlined based on the factors most important to service users. To understand which parts of AYSRH services need to be improved, we asked young people what mattered to them. While this may seem like an obvious first step, young people are often not invited to contribute to defining their challenges or creating solutions. We’re changing this approach by partnering with organizations like EngenderHealth, who share our commitment to youth inclusion.

M4M initiated a series of focus group discussions with global youth SRH leaders and organizations serving young people’s SRH needs to uncover the factors that most significantly impact the quality of SRH services in their respective countries. Several key themes emerged from these conversations. First, poor privacy and confidentiality practices and negative staff attitudes and behaviors present substantial barriers to young people seeking and accessing high-quality SRH services. Second, youth leaders emphasized that they and their peers should be a part of designing measures or interventions to improve the quality of AYSRH services. These insights were all truly informative; however, we will focus on the effects of healthcare providers’ negative staff attitudes and behaviors—known collectively as provider bias—in the remainder of this blog. 

These conversations paved the way for additional formative research and the founding of our new research program, the Measuring Youth Sexual and Reproductive Health (MY SRH) Initiative. This initiative’s primary objective is to create a youth-informed and easy-to-use measurement approach that young people, program managers, clinicians, and frontline health staff can routinely use to assess the quality and responsiveness of youth SRH services. We’re pleased to be joined in this journey by organizations like EngenderHealth.

A Closer Look at Provider Bias

Provider bias occurs when providers’ attitudes and subsequent behaviors unnecessarily limit client access and choice. This bias manifests in various forms and profoundly impacts the quality of care adolescents and young people receive.

Providers sometimes impose restrictions based on clients’ age, marital status, or the number of children they already have. This leads to inequalities in access to long-acting reversible contraceptive methods, including intrauterine devices, contraceptive injections, implants, oral contraceptives, and emergency contraception. In particular, young women, those who are single, lack spousal approval, and those perceived as not having enough children often encounter obstacles to these crucial services. Stigmatization, a potent force, is another consequence of provider bias. It discourages clients from disclosing vital health history and hinders their future health-seeking behaviors. Furthermore, provider bias contributes to method bias and inadequate counseling, which results in method dissatisfaction, a key predictor of contraceptive discontinuation.

Sometimes, their biases stem from misconceptions about specific contraceptive methods or insufficient knowledge and skills in providing them. More frequently, provider biases are rooted in deeply ingrained gender and social norms within their communities concerning the rights of women and young people. Even when providers don’t personally adhere to these norms, they operate in environments influenced by these beliefs, affecting the care they provide young people. It’s important to recognize that most healthcare providers genuinely care about their clients.  Rather than viewing healthcare providers as obstacles to progress, they are valuable partners in developing solutions to address and mitigate these biases and ensure equitable access to quality care for adolescents and young individuals.

Asking Young People What Matters to Them—and Listening!

We love to hear from young people, particularly when solving issues that impact them! So, we sat down to talk with Blandine Yeo to get her take on the obstacles facing young people seeking SRH services and possible solutions. Blandine is a young person working at EngenderHealth as a Program Communication Associate in Côte d’Ivoire. She has a unique perspective because she sees both sides of this issue—as a young person and someone working to improve AYSRH services. 

Bonjour, Blandine! Thanks for sitting down with us. We are excited to hear from you. First, we would like to know: What barriers do you think young people in your community face when trying to access high-quality SRH care? How are those barriers similar or different depending on the age, gender, or other identities some young people hold in your community?

Blandine: There are several obstacles facing young people in my community. It should be noted that sexuality among young people is a taboo subject in Côte d’Ivoire, which leads to the stigmatization of young people in reproductive health services; providers are often not very welcoming and make judgments about the young people who come to these services. There are also cultural and religious norms that maintain the taboo surrounding sexuality among young people, influencing their perception and causing them not to seek information in the right places to meet all their needs. Lack of communication between parents and children and their families is another challenge faced by young people.

These challenges often concern unmarried teenagers and young people from LGBTQ+ communities, who are mostly left to their own devices when it comes to their sexuality. Civil society organizations and institutions are continuing their advocacy work to ensure that all genders, all social strata, and all communities have free and equitable access to SRH services.

That is a lot working against young people trying to access SRH information and services. What is one thing you think youth-serving organizations like EngenderHealth need to do better to increase access to high-quality SRH care for young people? 

Blandine: An organization such as EngenderHealth needs to offer more capacity-building sessions for providers on gender, youth, and social inclusion so that they have a better understanding of the issues. They will then stop stigmatizing young people in need of SRH services and guarantee the confidentiality of services to reassure young people and encourage them to come forward. One of the other things that needs to be done is to sensitize parents, if not train them, in parent-child communication and comprehensive sexuality education. This orientation will enable parents to create healthy relationships with their children while encouraging mutual understanding, emotional support, and, at the same time, preventive communication that will enable parents to give children the right information and lead them to the health services that meet their needs. 

That is all excellent advice! We appreciate your insight on what we can do better and where to focus our work with young people. What do you wish SRH providers did to make accessing services easier and more comfortable?

Blandine: I think service providers need to give young people a warmer welcome by greeting them in a friendly and respectful manner, so they can comfortably discuss their needs and expectations in a safe and welcoming environment. In this environment, they should reassure young people that their personal information is completely confidential. On top of all this, providers must ensure that they offer quality services tailored to the needs of each individual.

Thank you for your time and insight, Blandine! We value your work and experiences and loved hearing from you on this critical issue.

How EngenderHealth is Addressing Provider Bias

At EngenderHealth, we recognize that adolescents and youth aren’t a homogenous group and that all members of a young community are responsible for contributing to creating a more enabling environment where young people can make informed decisions about their health and exercise their human rights. Still, as M4M’s work has found, provider bias is a central concern for young people. EngenderHealth addresses provider bias through four main approaches, all grounded in meaningful youth participation: engaging young people in all programming phases, working with communities to destigmatize sexuality and sexual health issues, educating young people about their rights and where to access SRH services, and advocating for supportive laws and policies. 

EngenderHealth partners with young people to address provider bias to ensure our work is done with, not just for them. We recognize young people as experts in their own bodies and lives and engage them in all programming phases to ensure that our work responds to their needs and priorities. Through our Strengthening Local Youth- and Women-Led Organizations to Become Key Actors in Promoting SRHR and Improving the Management and Prevention of Gender-Based Violence in West Africa program, we partner with 21 local youth-led organizations across four countries in the region to advocate for expanded access to a full range of SRH services, particularly for young people and girls. By including our youth-led partners in the design and implementation of programs, we can ensure that our programs address the root causes of provider bias, as seen by young people.

To address provider bias, we must create an enabling environment where the attitudes and behaviors of healthcare providers are non-judgmental, inclusive, and safe. A key part of EngenderHealth’s work is to strengthen healthcare providers’ capacity for unbiased, youth-responsive services through training, sensitization, and transforming gender norms. Through the Scaling up Family Planning program, we partner with Comprehensive Community-Based Rehabilitation in Tanzania, DKT International, and Pathfinder International to bring high-quality SRH services to Tanzania’s un- and underserved populations—particularly adolescents and persons living with disabilities. To meet these objectives and ensure no one is left behind, we train healthcare providers and apply gender, youth, and social inclusion across all program activities. 

When young people are aware of their rights, they can better stand up against provider bias when they experience it. EngenderHealth works with local partners to educate young people about their rights and where and how to access information and counseling on sexuality, safe sex, and a full range of SRHR services. We do this through community outreach activities, peer education, and increasing awareness among parents and other influential community members. In India, where the Guttmacher Institute estimates that two million adolescent women have an unmet need for modern contraception, our TARUNYA program has worked to provide young people with SRHR information since 2008. We work with local civil society organizations (CSOs) to improve the spaces where adolescents can access SRHR information and services, support peer education interventions, and work to educate community members to support young people better. 

At the broader societal level, EngenderHealth advocates for supportive laws and policies around AYSRH to address provider bias for long-term change. We implement the Rights-Based Approach for Enhancing SRHR in Ethiopia program in close partnership with the Ethiopian Women Lawyers Association and government partners, including the Bureau of Education, the Bureau of Health, and the Bureau of Women and Children Affairs. The program develops legal frameworks, creates awareness, and facilitates policy dialogues to ensure local policymakers and implementers can support young people whose rights have been violated.

EngenderHealth is committed to ensuring young people can access sustainable, high-quality SRH information and services from program design to advocating for national policies and policy updates. This work begins and ends with meaningful youth participation!

Overcoming Provider Bias Together

According to the World Health Organization, adolescents currently comprise one-sixth of the world’s population, which is predicted to grow through 2050. That means there are 1.2 billion adolescents in need of high-quality SRH information and services, and without a change, provider bias may cause many of those needs to go unmet. M4M’s innovative measurements provide a solid foundation for the intentional responses of organizations like EngenderHealth. By listening to and working alongside the young people we serve, we can effectively address provider bias and ensure that adolescent- and youth-responsive services are accessible, high-quality, affordable, equitable, and effective.

Learn more about the Measuring Youth Sexual and Reproductive Health (MY SRH) Initiative here. Find out more about EngenderHealth’s meaningful youth approach and programs here.