Safe spaces enhancing sexual and reproductive health for youth: a scoping review

Abstract

Introduction

Safe spaces play a crucial role in providing support for the sexual and reproductive health (SRH) of youth. As young individuals undergo significant physical and emotional changes, they often encounter challenges such as societal taboos and a lack of accessible information related to their SRH needs. This scoping review explores the existing literature on using safe spaces to offer a supportive environment for adolescents SRH to navigate these complexities.

Methods

This review adhered to Arksey and O'Malley's scoping review framework method. A comprehensive search was conducted across Medline, EMBASE, CINAHL, and Scopus for studies published between January 2013 and December 2023. It focused on youth aged 15 to < 25 years, including primary studies and grey literature in English from diverse global contexts, excluding non-English studies and scoping/systematic reviews. The screening was done using Covidence software by two independent reviewers. Data were extracted and analyzed using descriptive statistics and narrative synthesis to summarize the findings.

Results

Schools emerged as the most common safe spaces (37 studies), effectively increasing condom use, SRH knowledge, and service utilization. Community-based initiatives (e.g., youth clubs and outreach programs) were critical in reducing stigma and fostering positive SRH attitudes. At the same time, digital platforms demonstrated the potential to address high-risk behaviours and unplanned pregnancies. Interventions included educational sessions, resource distribution, counseling, and peer support. While most studies reported positive outcomes, the evidence for long-term efficacy and sustainability was limited.

Conclusion

Safe spaces hold significant potential to improve youth SRH outcomes by fostering informed decision-making and reducing risky behaviors. However, the effectiveness of interventions should be critically evaluated, with more emphasis on innovative, digital approaches and long-term impact. Tailored, inclusive, and sustainable strategies are essential to address the diverse needs of youth globally.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-025-02009-x.

Introduction

Sexual and reproductive health (SRH) issues among youth are a significant global concern [1]. Many young people engage in harmful sexual practices that expose them to a range of SRH risks, including unintended pregnancies, sexually transmitted infections (STIs), and gender-based violence [2]. For example, 11% of unintended pregnancies occur among youth, with 95% of these taking place in low- and lower-middle-income countries [3]. In addition to these risks, 1.5 million young adults died in 2021—approximately 4,500 per day—highlighting the broader health challenges that this population faces [4]. Youth are especially vulnerable to SRH challenges such as gender inequality, sexual coercion, partner violence, early marriage, unsafe abortion, and HIV/AIDS [5–8]. These challenges are further compounded by the limited ability of many young people to make informed SRH decisions, primarily due to a lack of access to accurate and comprehensive knowledge [9, 10]. Effective communication about SRH is critical for promoting positive choices and behaviors [11]. However, social norms, gender-based taboos, and cultural beliefs often hinder open and honest dialogue, particularly for adolescent girls [12, 13]. Additionally, parents often perceive adolescents as too young to discuss sexual matters, which restricts communication about SRH within families, especially in many cultural and religious contexts [13, 14].

Safe spaces are critical for overcoming these barriers among youth [12–14]. These environments allow young people to express themselves, share concerns, and engage freely without fear of judgment or ridicule [14]. Key features include a non-judgmental environment that welcomes all perspectives; confidentiality to protect privacy and build trust; a supportive atmosphere offering emotional and informational aid; inclusiveness that ensures accessibility for all, regardless of background; and empowerment, equipping youth with accurate SRH knowledge to make informed choices and advocate for their rights [13, 15]. Such spaces allow young people to access accurate SRH information, seek support, and freely discuss their concerns. Comprehensive sexuality education (CSE), as recommended by UNESCO, is a key component in fostering these safe spaces by equipping youth with the knowledge and skills to make informed decisions, build healthy relationships, and advocate for their rights [4].

Examples of safe spaces include community organizations [16], schools [17], youth clubs [18], and online platforms [19]. These spaces are vital in supporting positive development and fostering resilience among youth. They also help mitigate SRH risks by encouraging healthy behaviors, such as increasing the use of contraceptives and condoms [20, 21], decreasing unintended pregnancies [20], and preventing sexual harassment [22]. Despite the recognized importance of safe spaces, limited research consolidates the evidence on their effectiveness in promoting SRH and safeguarding youth SRH rights. This scoping review explores the existing literature on safe spaces for youth and their role in promoting SRH. Specifically, this review aims to address the following objectives:

1. To identify types of safe spaces used to promote SRH of youth.

2. To identify the interventions implemented in these safe spaces to promote SRH of youth.

3. To report the SRH outcomes related to safe space intervention.

Methods

Study design

A scoping review was conducted using the Arksey and O'Malley framework [23], which consists of six stages: (1) formulating the research question, (2) identifying relevant studies, (3) selecting studies, (4) organizing data, (5) summarizing and presenting findings, and (6) optionally conducting a consultation exercise. This review did not perform the consultation stage due to time and financial constraints.

Inclusion and exclusion criteria

We established inclusion criteria based on scientific literature, focusing on the population, concept, and context [23]. The population included youth aged 15 to < 25 years, consistent with global definitions of adolescence and young adulthood. The concept centered on safe spaces that promote SRH and well-being by providing non-judgmental, supportive, and empowering settings. The context was global, encompassing diverse cultural and geographical settings. The review included primary studies and grey literature published in English that specifically examined safe spaces for SRH among youth within the specified age group. Studies published in languages other than English and scoping or systematic reviews were excluded. These criteria guided the research strategy, ensuring a focused approach to identifying relevant studies.

Information source and search strategy

The University of Alberta’s librarian (MK) developed the search strategy in consultation with the review team, using Boolean operators, targeted keywords related to SRH and youth, and tailored filters to ensure a comprehensive search across relevant databases. The following databases were searched individually from inception to the present: Scopus (N = 2690), PsycINFO (N = 2500), EMBASE (N = 2866), MEDLINE (N = 1002), and CINAHL (N = 119), in addition to organizational websites. The search focused on terms related to adolescent and youth sexual and reproductive health (SRH), contraception, preconception, and sexual education. It also included terms like community, schools, online platforms, and youth clubs to identify safe spaces for promoting SRH. Non-human studies were excluded from the search. The entire search strategy is detailed in Supplementary file 1.

Screening and data extraction

We used Covidence, an online screening software [22], to screen the studies included to ensure they met the eligibility criteria. Two independent reviewers, SN and YA, completed the screening process, and a third reviewer (SM) resolved any conflict. All the studies were extracted using a Word document (Supplementary file 2). Details such as the author’s name, publication years, sample size, type of safe space, and outcomes of the studies were extracted.

Collecting, summarizing, and reporting results

Descriptive statistics were used to summarize and categorize the study characteristics, including the geographical location, study design, types of safe spaces, and the demographics of the youth populations. Narrative synthesis was employed to organize and synthesize the various interventions identified across studies, including educational programs, peer support initiatives, and community outreach activities.

Findings

Study characteristics

The search identified 10,177 papers; 5195 duplicate papers were removed. After the initial title and abstract screening, 4682 papers were excluded, leaving 300 full texts to be reviewed. Of these, 256 papers were excluded for not meeting our criteria, leaving 44 studies selected for extraction and synthesis (Fig. 1), published between 2013 and 2023. This study comprises diverse methodologies and geographic locations. Approximately 69% (n = 30) of the studies were conducted in high-income countries [16, 18, 20, 24–49], while the remaining 31% (n = 14) took place in low- and middle-income countries (LMIC) [17, 50–61].

Fig. 1.

Prisma Flow Chart

Most studies (19) were conducted in North America, primarily in the United States [11, 25, 27, 30, 32, 34, 38, 40, 42, 43, 46, 48–50, 63]. Africa followed with ten studies covering various countries, including Malawi, South Africa [51, 53, 58, 66] Uganda [52, 54, 62], Kenya [59], Tanzania [55], and Ethiopia [57]. Europe contributed eight studies from nations such as Sweden [64], Finland [26], the UK [18, 29], Spain [16], and the Netherlands [31, 47]. Asia had five studies covering Iran [33], Indonesia [17], Lebanon [44], and Bangladesh [59, 60]. Oceania had one study originating from Australia [45], while South America had one study from Latin America [56].

Regarding age groups, the studies targeted a wide range of populations. Adolescents and young adults aged 15–19 were the most common demographic studied across multiple regions. The sample sizes of the included studies varied significantly, with six studies involving 100 or fewer participants, 24 studies between 101 and 500 participants, and 14 studies involving more than 500 participants. Of all the included studies, the majority (26) were experimental [16, 25–30, 32, 35, 36, 38, 40, 46–48, 50–52, 54, 56, 58, 61, 63, 64], 15 were observational [17, 18, 31, 33, 34, 37, 41–45, 53, 57, 59, 60], one was qualitative [24], and 2 were mixed methods [49, 55] (Table 1).

Table 1.

Study Characteristics

Category	Frequency
Regions
North America	19
Africa	10
Europe	8
Asia	5
Oceania	1
South America	1
Sample Sizes
Less than and equal to 100	6
Between 100 and less than or equal to 500	24
Greater than 500	14
Study Types
Experimental	26
Observational	15
Qualitative	2
Mixed method	1

Types of safe spaces

Various safe spaces were used to support the youth regarding their sexual and reproductive health. These spaces encompass various settings and approaches, including school-based initiatives (37 studies) [11, 17, 24, 25, 27–40, 42–45, 47–52, 54, 56–59, 61, 63, 65], youth clubs [18, 38, 40, 43, 55–57], community centres outreach programs [3, 20, 26, 53], community settings [16, 27, 31], and digital platforms [1]. Each type of safe space offers unique opportunities for delivering sexual health education and promoting positive behaviours among adolescents. From classroom lessons and peer support programs to community outreach initiatives and online platforms, these interventions aim to address the diverse needs of young people and empower them to make informed decisions about their sexual health (Fig. 2).

Fig. 2.

Types of Safe Spaces

Interventions used by safe spaces

The included studies employed various interventions tailored to specific contexts and populations. These interventions encompassed a wide range of approaches, including community-based activities(19 studies) [16, 17, 26, 29–31, 38, 53, 54, 56], educational programs(17 studies) [18, 24, 26, 27, 29, 30, 32–34, 36–38, 43, 45–47, 49, 51, 52, 57, 59, 60, 63, 64, 66], distribution of resources(2 studies) [25, 66], counselling services(2 study) [16, 28], and peer support initiatives(5 studies) [26, 41, 42, 44, 55]. For instance, the Teen Prevention Education Program (28)(Teen PEP) aimed to educate adolescents on various health topics. At the same time, initiatives like free condom distribution in school corridors and community contraceptive counselling focused on increasing access to contraception.

Furthermore, interventions such as outreach health education, digital support groups, and peer-led education programs utilized innovative methods to engage adolescents and provide them with essential information on sexual health [35, 39]. School-based initiatives were particularly prominent, with programs like sexual health education interventions, HIV and pregnancy prevention efforts, and comprehensive sexuality education being implemented within school settings. These interventions by community-based initiatives, including outreach programs, community centres, and youth clubs, were vital in reaching adolescents outside the school environment.

Outcomes related to safe space interventions for youth

This scoping review highlighted several positive outcomes associated with interventions aimed at promoting sexual and reproductive health (SRH) among adolescents in safe spaces. These interventions led to increased condom use, as shown in ten studies [18, 25, 27–29, 33, 34, 54, 63, 66], which helped reduce the risk of sexually transmitted infections (STIs) and unintended pregnancies. Seven studies [18, 27–30, 32, 34, 39, 43, 47, 49, 57, 59, 66] reported enhanced sexual health knowledge, empowering adolescents to make informed decisions about their sexual health. Additionally, six studies [17, 18, 26–30, 32, 42, 51, 66] found improved attitudes toward sexual health, suggesting that these interventions fostered healthier sexual behaviors and attitudes. Five studies [18, 26–29, 33, 34, 39, 45, 53–56, 66] highlighted greater utilization of sexual health services, such as contraception and STI testing, indicating that safe spaces improved access to critical health services. Four studies [16, 24–26, 36, 41, 51, 53, 60, 64] demonstrated reductions in high-risk sexual behaviors and unplanned pregnancies, further emphasizing the importance of these spaces in mitigating adolescent sexual health risks.

Interventions also positively impacted communication with parents about sexuality [44, 51, 63] (3 studies), increased self-efficacy regarding sexual health [30, 51, 55] (3 studies), and helped prevent sexual harassment [31, 45] (2 studies). Some interventions showed significant effects on educational outcomes [58, 60] (2 studies) and reduced health disparities related to unintended pregnancies and HIV transmission [35, 37, 51] (2 studies). However, it is essential to note that some interventions did not achieve the desired outcomes [29, 52], underscoring the need for further research and refinement. Overall, the findings indicate that safe spaces have the potential to influence SRH outcomes among adolescents positively, but continued development and evaluation of these interventions are necessary (supplementary file 2).

Discussion

This review maps evidence on safe spaces aimed at improving the SRH of young people, shedding light on the diverse settings and interventions employed to address their needs [18, 27–30, 32, 34, 39, 43, 47, 47, 49, 57, 59, 66]. These safe spaces foster informed decision-making, empowerment, and reductions in risky sexual behaviors. Among the identified approaches, school-based initiatives emerged as the most prevalent and effective in promoting SRH knowledge and positive behaviours [18, 27–30, 32, 34, 39, 43, 47, 47, 49, 57, 59, 59, 66]. This aligns with existing literature emphasizing the role of schools as pivotal venues for SRH education [67, 68]. Beyond schools, outreach programs and community-based safe spaces demonstrated adaptability, reaching adolescents in diverse environments, including marginalized and underserved populations with limited access to formal education [69, 70]. This adaptability underscores the critical role of safe spaces in addressing inequities in SRH access and education.

The review identified multiple positive youth outcomes associated with safe spaces, including increased condom use, improved sexual health attitudes, greater utilization of SRH services, and reductions in high-risk sexual behaviors and unintended pregnancies [11, 71, 72]. These interventions also enhanced communication with parents about sexuality, bolstered self-efficacy regarding SRH, contributed to the prevention of sexual harassment and facilitated reductions in health disparities related to unintended pregnancies and HIV transmission. Some programs positively impacted educational outcomes, demonstrating the multidimensional benefits of these initiatives [34, 39, 43, 47]. However, while many interventions showed short-term effectiveness, there remains a significant need for evidence on their sustainability and long-term impact [57, 59, 59, 66].

Despite these promising findings, this review highlighted a critical gap in the use of digital interventions. The limited focus on digital platforms, particularly in low-resource or remote settings, is a missed opportunity to expand SRH support. Digital approaches, such as mobile applications and social media platforms, offer scalable solutions to deliver SRH information and services to young people, especially in regions where physical access to safe spaces is constrained. Addressing this gap in future research is imperative for leveraging technology to enhance SRH outcomes among youth. The review also emphasized the need for a holistic approach to SRH. Many interventions narrowly targeted specific SRH issues, such as STI prevention or contraception access. However, a comprehensive framework that integrates emotional well-being, gender equity, and relational dynamics is essential to address the broader determinants of SRH. Future research and program development should prioritize integrated interventions considering the interconnected aspects of adolescent health and well-being.

This study has notable strengths, including its comprehensive synthesis of diverse interventions and global perspectives. It provides valuable insights into the effectiveness of safe spaces in various contexts and highlights best practices for promoting youth SRH. To the best of our ability, this review thoroughly examines youth safe spaces and their involvement in SRH interventions globally. However, several limitations must be acknowledged. The predominance of studies conducted in high-income countries may limit the generalizability of findings to LMICs, where unique barriers, such as stigma, resource constraints, and limited healthcare access, significantly impact the effectiveness of interventions. The exclusion of non-English studies may have introduced a bias, reducing the comprehensiveness of the review. Additionally, reliance on self-reported data across many studies poses a risk of social desirability bias, and study quality variations may affect the synthesized findings' reliability. Potential publication bias, favouring positive outcomes, also warrants consideration.

Implications

This review underscores the need for more research in LMICs to understand better the effectiveness of safe spaces in addressing SRH needs. Research funding agencies should prioritize proposals on youth space intervention strategies for SRH from LIMCs to bridge this knowledge gap. Furthermore, the review highlights the importance of understanding the comparative effectiveness of different safe space modalities in promoting SRH outcomes among youth. Longitudinal studies are needed to assess the sustainability of these interventions, which is crucial for scalability and long-term effectiveness. Lastly, there needs to be a significant gap in exploring digital interventions for youth SRH, particularly in low-resource or remote settings. Future research should focus on innovative digital approaches such as mobile apps and social media platforms, assessing their accessibility, acceptability, and effectiveness in diverse settings and populations. Finally, qualitative and mixed methods research designs could offer a context-specific understanding of factors to consider when planning safe spaces on SRH.

Conclusion

Safe spaces have emerged as crucial components in addressing the challenges faced by young people in navigating their SRH. These environments provide a supportive haven where youth can access accurate information, seek assistance, and cultivate healthy behaviours. The positive outcomes observed in communication, self-efficacy, sexual harassment prevention, educational achievements, and reduction of health disparities underscore the potential impact of targeted interventions within safe spaces. While safe spaces prove instrumental, further research is essential to refine and evaluate the interventions implemented within these environments. This iterative process ensures that interventions effectively meet the diverse needs of youth and contribute to sustained positive SRH outcomes for youth on a global scale. The findings of this scoping review underscore the importance of adopting holistic and inclusive approaches to promoting youth SRH. By leveraging diverse, safe spaces and intervention strategies, stakeholders can work towards empowering young people to make informed decisions about their sexual health and well-being, ultimately contributing to improved SRH outcomes and overall quality of life for adolescents globally.

Author contributions

Salima Meherali: conceptualization of the scoping review, oversight of the review process and methodology, supervision and guidance throughout the review process, review and approval of the final manuscript. Yared Asmare Aynalem: Literature search and screening for inclusion criteria, data extraction and synthesis. Writing drafts Saba Nisa: Literature search and screening for inclusion criteria, data extraction and synthesis. Writing drafts Adeyinka G. Ishola: Review the manuscript, contribution to the interpretation of findings. Zohra Lassi: Supervision and guidance throughout the review process. Review and approval of the final manuscript.

Funding

None.

Availability of data and materials

All relevant data is available in the supplementary file and within the manuscript itself. No datasets were generated or analysed during the current study.

Declarations

Ethics and consent to participate

This study did not involve human subjects.

Consent for publication

Not applicable.

Competing interests

All authors declared no conflict of interest.