Despite global commitments, meeting the sexual and reproductive health (SRH) needs of young individuals still falls short. Our research with youth leaders reveals two primary challenges: inadequate privacy and confidentiality practices at service points and provider bias. Through a follow-up literature review, we found ample evidence supporting the observations of adolescent and young adult focus group participants—that poor privacy and confidentiality practices in SRH services were frequently linked to poor perceptions of service quality by young people. Furthermore, findings and observations confirmed that provider bias is a key barrier to accessing SRH services.

Accessible and user-centered measurement approaches are crucial to advancing youth-friendly SRH quality and coverage. However, no measure allows for rapid assessment of the combined concepts of privacy, confidentiality, and provider bias.

To fill this measurement need, we have founded the Measuring Youth Sexual and Reproductive Health (MY SRH) Initiative, a research program whose aim is to develop a robust, evidence-based tool designed to aid health program implementers and managers, funders, researchers, and similar stakeholders to easily and effectively assess the quality and friendliness of youth SRH services. This tool will drive continuous improvement and guide interventions targeting barriers to SRH services for adolescents and young adults.

In July 2023, at Women Deliver in Rwanda, we convened a globally representative group of young SRH experts and advocates to define the measurement needs in adolescent and youth SRH (AYSRH) service provision. In partnership with YIELD Hub and our 22 youth avisory group (YAG) members, we discussed the unique barriers that poor privacy and confidentiality practices and provider bias create for adolescents and young adults seeking high-quality SRH services. During the meeting, YAG members further characterized the most important features of these key concepts:

1. Privacy applies to all service channels, including physical and digital records, and auditory and visual privacy.
2. Confidentiality requires well-designed policies and workflows to ensure that young people’s private health information is not disclosed without their consent.
3. Provider bias, including discrimination, stigma, and lack of knowledge, can limit access to quality SRH services. High levels of bias can lead to poor quality of care, denial of services, and reduced access to care.

The group also came to a consensus on the services that matter most to youth:

1. Comprehensive sexual education
2. Safe abortion and post-abortion care
3. Contraceptive services
4. Preventative screening
5. A gender-based violence counseling

Without a focus on measurement, youth may face poor outcomes that include unplanned pregnancies, coercive care, stigma, and fear of care providers, which can lead to future morbidity and mortality.

Measuring privacy, confidentiality, and provider bias is essential in advancing AYSRH.

Join the global movement and help us to advance measurement of AYSRH service quality!