A Social Ecological Approach to Exploring Barriers to Accessing Sexual and Reproductive Health Services among Couples Living with HIV in Southern Malawi

Table 1

Barriers to accessing sexual and reproductive health services.

Individual level	Intrapersonal level	Organisational level	Community level	Societal level
Skills; (i) Reading; (ii) Writing; Attitudes; (i) Stigma and discrimination; (ii) Embarrassment; Beliefs; (i) Gender and  cultural beliefs  about reproductive  health; Knowledge; (i) Past negative  experiences	Partner; (i) Attitudes, beliefs, and knowledge about sexual and reproductive health services; Friends; (i) Misinformation from peers; (ii) Disapproval from friends; Family; (i) Family structure; (ii) Disapproval from kin	Rules; (i) Inconvenient service hours; (ii) Disapproval from health workers; Structures formal and informal; (i) Geographical accessibility; (ii) Inadequate counselling from health workers; (iii) Lack of privacy	Established norms and values; (i) Rigid gender roles; (ii) Loss of traditional support; Standards; (i) Economic hardships encountered by informants	National policy; (i) National policies on sexual and reproductive health, HIV, and AIDS; (ii) Lack of free services of some sections of the sexual and reproductive health services; (iii) Conflicting information from health institutions and from media