Table 2.

Emerging themes, sub-themes, and representative quotations

Theme 1: Public transportation shutdown. An early, country-wide public transport shutdown deterred youth SRH access, leading to decreased facility utilization of contraception, antenatal and delivery care services.
Youth	“A youth will think of going to a clinic even if it is far, they need transport and there were no transport means during the COVID-19 and they cannot walk up to there, so they decide to stay with their challenges till COVID-19 ends...”
Theme 2: Mask mandate. Required face-covering discouraged youth care-seeking early in the pandemic due to limited availability and youth finances. Youth either chose not to visit health facilities or were turned away.
Youth	“Yes, [COVID-19] has impacted our access and uptake of these services, because sometimes if you do not have a mask or even money to buy it, you cannot go to a health center for services because health workers will not treat you and you will stay with your disease, you can even die.”
Youth	“usually when [youth] reach the health facility and they do not have masks nor money to buy them, they are chased by health workers to go back home, and they have no option but to go back unattended”
Theme 3: School/workplace closure. A large proportion of youth working and schooling in urban centres returned to home villages, dramatically increasing youth populations. Youth-expressed fears of lost anonymity and confidentiality while care seeking at local facilities led to a significant decrease in SRH care-seeking compared with being at school, especially for contraception and STD testing. Increased youth pregnancy, abortions, and infections were reported outcomes. Attending local clinics during lockdown often necessitated parental awareness; youth feared reporting back to families in contrast to usual anonymous services available at schools/urban/away-from-home settings.
Youth	“…we hear that many… have become pregnant because there are no measures. If you ask youths who have been using condoms before, they are no longer using them... It was easier for them while they were still at school because they would pretend that they are going to buy books and they end up buying condoms without anyone knowing, but now at home they say, “our neighbor is my mother’s friend, won’t he tell her that I bought condoms from him?”
Community Leader	“[Youth] are scared of meeting their parents or other relatives at these facilities, …they fear their parents finding out.”
Youth	When they go to the health facility, they will go to the same table as patients with other diseases, they will meet their neighbors and by the time [health workers] treat that youth, the neighbor will be aware of the disease she is suffering from...”
Health Worker	“We are having so many youths and adolescents in communities, and most of them like feel shy to come and access these services… for example you get a report that there is a girl here or a youth here, who had unsafe abortion and is failing to come to the facility.”
Subtheme 3a: Facilities ill-prepared/SRH commodity shortages. Demand for youth-oriented commodities (i.e., condoms, birth control pills) and youth service/consultation was lower before COVID-19. Due to a surge in youth population, unprepared and under equipped facilities posed a care- seeking barrier for youth.
Health Provider	“… the reason why they are not coming to government facilities... Now if she comes today wanting [injectable contraceptive] and she finds it not there, she will not come tomorrow and she will tell her fellow[youth]…”
Youth	“…now, [during lockdown]… a girl might not ask him to look for condoms because they know that these condoms are hard to find.”
Health Worker	“…there are some commodities which you find we do not have, a youth will come telling you she wants family planning for one month and yet for us we have implants, you cannot put an implant in a lady who is 15 years old.”
Theme 4: Lockdown. Restricted travel and work reduced family incomes and resulted in crowded living conditions. Social and financial stressors and isolation increased youth risk (especially amongst females) of forced early marriage, gender-based violence, and family violence; seeking help was often not possible.
Health Provider	“…there was a 13-year-old girl who was pregnant, and she had a complication… she told us that her paternal aunt was given 50 000 shillings [~15USD] and she gave her away for marriage.”
CHW Coordinator	“During this COVID-19 period, gender-based violence has greatly increased… in this season financial issues have increased, and it leads to violence between a wife, husband and children.”
Subtheme 4a: Youth mistreatment, family violence & GBV. Crowded living conditions and family financial insecurity led directly and indirectly to youth mistreatment. Some female youth fled homes to escape labor, domestic violence, and poverty, becoming ‘house girls’ elsewhere or partnering with same-age or older men. Often females ‘used’ for sexual activity and/or impregnated were subsequently abandoned.
CHW Coordinator	“There is so much gender-based violence because you find that a 14-year-old girl is married to a 20-year-old man who tries to look for employment but things are a bit tough, if their child wants to drink milk, they cannot afford it...”
Youth	“There are some families that are always fighting, so girls make up their minds that ‘in case I find a man who can take me in, I will leave this violent family”.
Parent	“…due to COVID-19, gender-based violence has increased in families and it has affected children, to an extent that some children have left their homes and are now on streets.”
Subtheme 4b: Increased population of idle youth. An expanded population comprising newly ‘out-of-school’ and unemployed youths with more leisure time resulted in earlier and more youth sexual activity. Combined with limited contraception availability and decreased youth SRH care-seeking, teen pregnancies, and SRH complications reportedly increased.
Community Leader	“[Teens] are all in villages lousing around, those who have been in segregated schools are now able to access their opposite gender and engage in sexual intercourse, most girls have become pregnant, others have gotten married before they are ready.”
Youth	“Most of [the 14- to 15-year-olds] have gotten married during this COVID-19 period, since they are in villages.”
CHW	“…most times they were in schools and now the population is increasing because they are in the villages doing nothing, that is why most of them are getting pregnant, most of them are aborting, because they are idle, have nothing to do.”
Parent	“COVID-19 has caused congestion of young people … and challenges have increased, 13 and 14 year girls are also getting pregnant and this is because adolescents have become many in the community and their interactions have also increased.”