Abstract
OBJECTIVES: Adolescent girls and young women (AGYW) in sub-Saharan Africa face persistent challenges in meeting their sexual and reproductive health (SRH) needs, contributing to high rates of unintended pregnancies and sexually transmitted infections (STIs). This study aimed to assess the prevalence and key determinants of unmet SRH needs among sexually active AGYW living in the Haut-Sassandra region, Côte d'Ivoire. STUDY DESIGN: Cross-sectional study. METHODS: This cross-sectional study, conducted in October 2023, included 342 sexually active AGYW randomly recruited from schools and public spaces within a 30-km radius around Daloa. Data were collected via a pre-tested quantitative questionnaire administered face-to-face. Unmet SRH needs were defined according to a multidimensional framework inspired by recent literature, encompassing both contraceptive and sexual health aspects, specifically, the coexistence of a desire to avoid pregnancy and inconsistent condom use and/or a history of unplanned pregnancy, abortion, or STI diagnosis in the past 12 months. Poisson regression models with robust variance were used to identify associated factors. RESULTS: In total, 303 participants were included in the analyses. The mean age was 20.3 ± 2.8 years, and the overall prevalence of unmet SRH needs was 48.5 %. Sociodemographic factors positively associated with unmet needs included being married or cohabiting (p = 0.018), attending school (p = 0.029), living in an urban area (p = 0.005), and receiving money from non-family sources (p < 0.0001). Behavioral factors such as alcohol, drug, and/or tobacco use (p = 0.009) and having two or more sexual partners (p = 0.015) were associated with increased unmet needs. At the contextual level, experiencing gender-based violence (p = 0.0001) and endorsing inequitable gender norms regarding sexual decision-making and condom use (p = 0.019) were significantly associated with unmet SRH needs. CONCLUSION: Sexually active AGYW in Haut-Sassandra face substantial challenges in meeting their SRH needs. Research-action studies are needed to design youth-driven interventions addressing inequitable gender norms and gender-based violence.