Melaku Birhanu Alemu, Richard Norman, Yuanyuan Gu, Tigest Tamrat, Daniel Gashaneh Belay, Jaya A.R. Dantas, Gavin Pereira, Gizachew A. Tessema
Adolescents and young adults (AYAs) in Ethiopia face significant sexual and reproductive health (SRH) challenges, yet service utilisation remains low, partly because current services could better align with their preferences. This study assessed AYAs' preferences for SRH services. We conducted three distinct but interrelated discrete choice experiments (DCEs) on contraceptive services, abortion care, and sexually transmitted infection (STI) services between February and April 2024 in Ethiopia. A D-efficient design with two blocks of 24 choice tasks was used. A mixed logit model was used to estimate attribute importance, willingness to pay (WTP), choice probabilities, and preference heterogeneity. Analyses were weighted to improve representativeness and comparability. A total of 984, 990, and 990 participants completed the contraceptive, abortion care, and STI DCEs, respectively. The majority of respondents were from urban areas. Privacy was the most important attribute for contraceptive and abortion care, while quality of care dominated in STI services. Privacy and quality of service were three times more valued than the attitude of the healthcare providers. Respondents from rural and regional areas prioritised privacy, whereas urban and metropolitan participants valued high-quality care. Under optimal conditions, predicted service uptake reached 95 %, compared to 10 % under unfavourable scenarios. The highest WTP (2923 Ethiopian birr/54 USD) was observed to avoid poor-quality STI services. Privacy and service quality emerged as the most important attributes influencing the uptake of SRH services among AYAs. However, there is preference heterogeneity among sociodemographic groups, underscoring the need for context-specific interventions. © 2025 The Authors.
Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, 6102, WA, Australia; Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia; Macquarie University Centre for the Health Economy, Australian Institution of Health Innovation & Macquarie Business School, North Ryde, 2113, NSW, Australia; UNDP/UNFPA/UNICEF/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland; Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; enAble Institute, Curtin University, Kent Street, Bentley, 6102, WA, Australia; Faculty of Medicine, Universitas Negeri Malang, Indonesia
