1. Operational Research on young people’s uptake of services in Indonesia Presented in the International Conference of Family Planning 9-12 November 2015, Nusa Dua Bali, Indonesia

2. [Footer]2 Opportunities for Increasing the Uptake of Sexual and Reproductive Health Services among Under-served Young People in Indonesia Experiences in Indonesia: What works and what needs to be invested in order to improve the SRH service uptake among (unmarried) young people in the DIY Province

3. [Footer]3 About the research PRECEDE-PROCEDE Theory was used as the research framework (Green, 1980) Methodology – Qualitative research (June – Oct 2015) in Yogyakarta (DIY) Province – Interviews and FGDs with: Young people (who had accessed SRH services): 42 respondents Health providers & health commodities suppliers: 11 respondents Approach: Access to and use of contraceptives vs. general SRH service uptake

4. [Footer]4 When do young people actually go to SRH services? “I finally made up my mind to go to the hospital in my desperation to solve my vaginal discharge problem, which has gotten worse and affecting my activities and which has not gotten better with self-treatment” (Female respondent, Yogyakarta) “I saw red spots on my body… I am afraid I got STI, then I went to see a private medical specialist in skin and genital diseases …” (MSM respondent, Yogyakarta)

5. [Footer]5 Learning from OR findings: What have influenced young people to seek for SRH services? Predisposing Factors  have direct influence Strongest influence: Having (serious) SRH problems Having (limited) SRH and SRH services knowledge Reinforcing Factors: Strongest influence: Availability of Peer Educators/support group in providing SRH information and accompaniments (who understand the problems and situation) when accessing SRH services Enabling Factors: Strongest influence: Availability and accessibility of youth friendly SRH services Both Reinforcing and Enabling Factors have indirect influence on young people’s decisions to use SRH services

6. [Footer]6 Searching for Information e.g. Internet/social media, friends/family, experts/activities, or additional sources Self-Treatment e.g. self-medication, traditional medicine Occurrence of SRH issues/symptoms e.g. STI symptoms, unwanted pregnancy, etc. Cure/ Successful treatment No Cure/ Failed Treatment 1 2 5 SRH Service Uptake at Formal Providers 8 7 No SRH Knowledge Existing SRH Knowledge 3 6 Young People’s Pathways to SRH Service Uptake

7. [Footer]7 What has worked in improving the SRH service uptake among (unmarried) young people in DIY Province? SRH programs provide sources of information on SRH and SRH services  important in shaping the decision to seek care Availability of youth friendly SRH services that ensures full privacy and confidentiality is available, but limited  private SRH facilities were preferred Role of midwives and Puskesmas  important in the provision of SRH services for young people living in sub urban and rural areas Protection and assurance of laws and regulations for (public) SRH providers is needed  to perform safe abortion and contraceptive provision Peer educators: preferred sources of information and accompaniment for young people when entering the SRH care trajectory A short or long pathway taken by young people towards formal SRH service uptake  the current SRH pathway shows a secondary type of prevention, NOT primary type of prevention

8. [Footer]8 What we have to invest to increase SRH Services uptake? (1)  Include prevention strategies (CSE / access to contraception)  Address barriers to access services related to guilt, stigma, and fear of rejection  Facilitate and strengthen Puskesmas in the delivery of YFS  Strengthen the role of peer educator as an effective strategy  Encourage meaningful youth participation and decision making in SRHR programmes and organisations

9. [Footer]9 What we have to invest to increase SRH Services uptake? (2) Programmatic  Improve content and access of SRH information according to local context  Use various channels preferably the ones preferred by young people  Build and strengthen SRH networks and referral system (Including with Puskesmas and midwives)  Strengthen PE and companionship system  Strengthen advocacy efforts on promoting short and long action contraceptives for (unmarried) young people in the ASK programme (through its partners and networks) Future research  Explore potential future research on: A comprehensive PKPR Program Review/Evaluation  to be used as a reference point for improving the role of Puskesmas How to improve Puskesmas role in being a key SRH service provider for unmarried young people How to integrate public and private SRH services effectively Exploring needs regarding the use of long acting contraceptives for (unmarried) young people

10. [Footer]10 Key Message for Future Successful SRH Program in Indonesia Strategies to increase uptake of SRH service for young people should be multi- targeted, sector-wide, comprehensive, timely and developed with and employ methods that foster participation of young people