Abstract
Introduction: Young people’s access to sexual and reproductive health (SRH) services in primary health care (PHC) facilities is shaped by intersecting social identities including gender, age, disability, socioeconomic status, and sexual orientation. In Karu Local Government Area, Nasarawa State, Nigeria, these intersecting identities compound existing structural barriers to SRH access, yet empirical evidence on their joint influence remains limited.
Methods: A convergent mixed-methods was employed. A structured questionnaire was administered to 385 young people aged 15–24 years across three PHCs, yielding 376 valid responses (97.7% response rate). Qualitative depth was provided by two focus group discussions and five key informant interviews. Descriptive statistics, chi-square tests, and binary logistic regression were used for quantitative analysis. Qualitative data were analyzed thematically. The study was grounded in intersectionality, the Health Belief Model, and the Social Ecological Model.
Results: A total of 42.1% of respondents reported discrimination in PHC settings, primarily attributed to economic status (23.9%), age (22.3%), and gender (19.2%). Only 56.3% felt safe accessing SRH services. Gender, education, income, and disability were significant predictors of perceived safety (P<0.05). Just 29.1% perceived PHC staff as responsive to diverse youth needs. Qualitative findings revealed breaches of confidentiality, moral judgement, and exclusionary practices particularly affecting LGBTQ+ youth and persons with disabilities.
Conclusion: Intersectional discrimination, compromised safety, and inadequate staff responsiveness undermine equitable SRH access for young people in Karu PHCs. Strengthening provider sensitivity, enhancing privacy infrastructure, and embedding intersectionality into PHC policy are essential for building youth-centred, inclusive health systems in Nigeria.