Comparing youth-friendly clinics to the standard of care for adolescent girls and young women in Malawi: A qualitative analysis.

Adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) face difficulties accessing sexual and reproductive health (SRH) services. Youth-friendly service delivery models may prove an alternative to increase SRH service uptake. This analysis utilises evidence from the Girl Power-Malawi study, a study designed to compare the impact of different models of service delivery on SRH service uptake for AGYW. Three intervention clinics trained providers in youth-friendly health services (YFHS), engaged young peer educators in patient outreach, expanded hours and integrated various services into youth-dedicated spaces. A standard of care (SOC) clinic was included as a comparator. This paper draws on qualitative data from in-depth interviews with 60 participants (15 per clinic) and 8 focus group discussions (2 per clinic). Thematic analysis identified three key themes regarding SRH service acceptability: having peer educators made AGYW feel more comfortable seeking services; AGYW perceived services at intervention clinics to be more private; and clinic modifications such as free services, longer operating hours and integration of different SRH services made services easier to access. Adolescents expressed that these factors contributed to higher service uptake in intervention clinics. Youth-friendly service provisions are needed to ensure AGYW find care-seeking acceptable.