Adolescents and young adults’ preferences for sexual and reproductive health services in Ethiopia: Evidence from three discrete choice experiments

Abstract

Introduction 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. Methods 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. Results 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. Conclusion 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.