Gender lens review of adolescent health care services: a mixed methods study in Bangladesh

The application of a gender lens enables the identification of gendered power dynamics that are deeply embedded within structures and institutions. This study delved into a comprehensive analysis of gender norms of male and female adolescents in terms of their health needs, the type of health services offered to them, the barriers and facilitators for utilization of health services at the adolescent-friendly health services (AFHS) across different tiers of government health facilities through a gender lens. The study was conducted at 23 health facilities across four districts of Bangladesh from February 2022 to June 2022. The study design was cross-sectional with a mixed methods approach. A total of 304 adolescents completed the survey, and 28 adolescents participated in in-depth interviews (IDI). Key-informant interviews (KII) were conducted with 48 key stakeholders, including parents, teachers, health service providers, facility managers, and health managers. Quantitative data were analyzed using descriptive statistics, and qualitative data was analyzed using thematic analysis. Adolescents have different needs for information about services, types of services provided, and use based on gender. There was a significant association between the marital status of adolescents and the need for different types of health services (P<0.05). Female adolescents receive tetanus-diphtheria (TD) vaccinations and iron folic acid (IFA) tablets, while male adolescents can receive them upon request. TD immunization is common among married female adolescents (14.9%) compared to unmarried female adolescents (11.8%) and unmarried male adolescents (1.1%). Unmarried female adolescents (36.1%) seek help more frequently for menstrual problems, while unmarried male adolescents (24%) are more likely to seek services related to puberty. Parents, teachers, and health service providers have different gendered perceptions of male and female adolescents’ health needs and use of health services. These perceptions contribute to understanding male and female adolescents’ utilization of services. This study reveals that gender norms influence adolescents’ health needs, types, and utilization of services. This is probably due to differences in gendered perception of the critical stakeholders for adolescents, who sometimes face barriers in the utilization of health services at the facilities.