Determinants of service utilization and satisfaction with sexual and reproductive health services among displaced and migrant populations in Nigeria: a cross-sectional study.

Abstract

Background: Understanding the determinants of access to sexual and reproductive health (SRH) services in humanitarian settings, and their links to client satisfaction, is essential for effective programming. The primary objective of this study was to describe the levels of utilization of services providing modern contraceptives, STI services, cancer screening, and GBV management among women and men facing humanitarian crises. The secondary objective was to determine the associations between clients' perceived ease of access and their satisfaction with the services received.

Methods: This was a secondary analysis of the data of a cross-sectional study conducted in five Nigerian states (Borno, Taraba, Yobe, Cross River, Benue) in December 2024. The study participants were refugees, internally displaced persons (IDPs), and migrants. Data were collected via interviews using a structured questionnaire. Utilization of five SRH services (modern contraceptive counseling, STI screening/treatment, cervical and prostate cancer screening, and GBV management) was assessed. Multivariable logistic regression was used to identify factors associated with service utilization, and cross-tabulations examined the link between perceived ease of access and satisfaction.

Results: The study included 1,194 sexually active adults (842 women, 352 men). Service utilization was highly gendered. Compared to refugee women, IDP women had significantly lower odds of utilizing contraceptive (AOR: 0.50; 95% CI: 0.34-0.72) and STI services (AOR: 0.66; 95% CI: 0.44-1.00), while migrant women had higher odds of utilizing cervical cancer screening (AOR: 3.04; 95% CI: 1.70-5.44) and GBV management (AOR: 2.12; 95% CI: 1.09-4.09). For men, migrants had higher odds of utilizing STI services (AOR: 2.75; 95% CI: 1.37-5.54) and prostate cancer screening (AOR: 11.63; 95% CI: 3.47-38.98) compared to refugees. A strong, consistent association was found between ease of access and satisfaction. Over 93% of clients reporting 'easy' access were satisfied, while satisfaction plummeted to 20.8-33.3% among those reporting 'uneasy' access.

Conclusion: Utilization of SRH services is shaped by gender, displacement status, and service type. The link between perceived ease of access and client satisfaction underscores that the process of obtaining care is as critical as the clinical service itself. SRH programs must adopt tailored, client-centered approaches that address unique sub-population barriers and systematically reduce logistical friction to improve both service utilization and quality of care.