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Background The number of young people utilising sexual and reproductive health services in Pacific Island Countries and Territories remains poor despite the availability and the existence of the fundamental rights to access these services. Adolescents and youth need accurate information and timely access to contraceptives to prevent adverse consequences associated with unintended pregnancies, abortion, childbirth and untreated sexually transmitted infections. This scoping review identifies and analyses factors contributing to young people’s low access to sexual and reproductive health information and services in this region. Methods Guided by the PRISMA Scoping review guidelines, we searched three databases (Medline Ovid, Scopus and CINAHL Complete) for peer-reviewed articles published between 1st January 2000 and 31st August 2020 that reported on factors, including barriers and enablers, affecting access to sexual and reproductive health information and services by young people living in Pacific Island Countries and Territories. We assessed the quality of each study according to the study designs, methods of data collection, data analysis and ethical considerations. All information was sorted and organised using an Excel Spreadsheet. Text data from published articles were charted inductively using thematic analysis with no predetermined codes and themes. Findings Five hundred eighty-nine articles were screened, and only eight met the inclusion criteria outlined in this scoping review protocol. These eight articles reported studies conducted in four Pacific Island Countries and Territories: Cook Islands, Fiji, Papua New Guinea, and Vanuatu. Factors such as lack of accurate sexual and reproductive health knowledge and social stigma were the leading causes of young people’s limited access to sexual and reproductive health services. Cultural and religious beliefs also invoked stigmatising behaviours in some family and community members. Conclusion This scoping review revealed that social stigma and judgemental attitudes imposed by family and community members, including healthcare providers, hinder young unmarried individuals in Pacific Island Countries and Territories from accessing sexual and reproductive health information and contraceptives. Alternatively, a non-judgmental healthcare provider is perceived as an enabler in accessing sexual and reproductive health information and services. Moreover, given that only a few studies have actually focused on young people’s sexual and reproductive health needs in the region, more research is required to fully understand the health-seeking behaviours of young people in their specific contexts.
A scoping review was conducted following the guidelines for the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Review (PRISMA-ScR) [29]. With the increase in the number of published scoping reviews and the lack of consistency in the methodology and reporting of results, the PRISMA-ScR checklist was developed following the guidelines of Levac, Colquhoun and O’Brien [30], who built upon the scoping review methodology of Arksey and O’Malley [31]. A protocol was written (unpublished; S1 Appendix) to guide the search for both qualitative and quantitative studies that would help answer our review questions. Medline (Ovid), CINAHL Complete and Scopus databases were searched using keywords and medical subject headings (MeSH) terms between 7th and 18th September 2020 (S2 Appendix). These three databases have a comprehensive overview of global literature in the fields relating to human life. We also searched Google Scholar, PubMed, -JCU One Search and Web of Science for additional information. Eligibility criteria are as follows; We limited our search to include articles published in English between 1st January 2000 and 31st August 2020. We were interested to understand what had transpired in the Pacific region during these twenty years, as there had been targeted SRH service activity linked to the Millennium Development Goals (MDG) and, more recently, the Sustainable Development Goals (SDG). In 2000, the United Nations Member States embarked on eight MDGs to fight poverty and combat issues hampering human development progress [9]. In these MDGs, goal five aimed to improve maternal health through two indicators; reduction of maternal mortality by three quarters and access to reproductive services. The literature identified using keywords and MeSH terms were downloaded into an Endnote library (Version 9) and screened using the established inclusion and exclusion criteria (S1 Appendix). After the screening process, we assessed the quality of each peer-reviewed article in our inclusion list according to the types of study design, methods involved in data collection and analysis and ethical considerations [32]. We then extracted data from the included studies using a standardised template in an Excel spreadsheet and organised text data according to; the age and gender of the participants, location of the study, study design, method of data collection, ethical considerations and SRH issues such as access to contraceptives and STI detection and treatment. Our text data were analysed inductively using thematic analysis [33]. The results sections of each included article were read several times for familiarisation with no predetermined codes. Finally, codes were created using NVivo (12 Plus version) software and linked together using thematic maps [33] to determine the themes related to barriers and enablers to young people’s access to SRH information and services in PICTs.
