© OCTOBER 2023

Despite comprising only about one-tenth of the global population in Africa, the region accounts for a disproportionate 20 per cent of worldwide births and nearly half of all maternal deaths during pregnancy and childbirth. Poor reproductive health is a significant contributor to the global disease burden, particularly affecting women of reproductive age. This dire situation is partly attributed to limited access to essential reproductive health interventions. For example, contraceptive use among married women in Sub-Saharan Africa is notably low at 13 per cent, leading to a high total fertility rate of 5.5 children per woman and an elevated adult lifetime risk of maternal death, with Africa having the highest risk at 1 in 26, while developed countries have the lowest risk at 1 in 7,300.

The study's objective was to investigate the factors influencing the uptake and utilization of reproductive health services among women of reproductive age in South Sudan's public health facilities.

The study employed a mixed-methods approach, including a longitudinal ecological study and an analytical cross-sectional study, conducted in selected States - Western Equatoria and Central Equatoria. The target population included women aged 15 to 49 visiting health facilities during the study period and key informants involved in reproductive health services and policy implementation. Data collection methods included structured questionnaires, in-depth interviews, focus group discussions, and data abstraction tools. Quantitative data analysis involved descriptive statistics and inferential analyses, while qualitative data underwent content and thematic analysis to identify common patterns and trends.

The study's findings in South Sudan's public health facilities indicate that a significant portion of respondents (72.5%) utilized reproductive health services, with family planning and STI prevention being the most used (25.1% each), followed by maternal and newborn care (18.1%) and HIV counselling and testing (15.3%). While overall uptake of reproductive health services increased over the years, there were declines during the third quarter from 2015 to 2020, coinciding with the rainy season.

Extreme weather events, like flooding and drought, hindered access to services for over 35% of women surveyed. Socio-cultural factors played a role, with age, place of residence, and educational level influencing utilization. Furthermore, awareness of nearby clinics, distance from clinics, and the availability of specific contraceptives were related to service utilization. Adequate and qualified healthcare staff, education levels, manageable workloads, and fair compensation were identified as crucial factors in improving reproductive health service delivery and access in South Sudan's public health facilities.

To enhance the uptake and utilization of RHS among women of reproductive age in South Sudan's public health facilities, several recommendations should be implemented. These include improving the availability of RHS by ensuring a consistent supply of essential resources and adequate staffing, raising awareness about free RHS through targeted campaigns, addressing seasonal variations and climate-related challenges, mitigating socio-cultural barriers, enhancing health facility characteristics to improve geographical accessibility, strengthening the health workforce through training and capacity-building, and providing competitive compensation packages and a supportive work environment for healthcare providers.

These measures collectively aim to improve reproductive health outcomes and access to services for women in South Sudan. Top of Form Further research can delve deeper into specific interventions and their effectiveness in overcoming these determinants to enhance RHS utilization and ultimately improve reproductive health outcomes for women in South Sudan.