Written By: Israel Chiagoziem Obioma
“The system, to a large extent, causes its own behavior.” — Donella Meadows
A few months ago, during a sexual and reproductive health outreach in my faculty, I asked young people why they rarely visit youth-friendly centers for free contraceptives. Their answers didn’t point to ignorance or lack of interest. It was fear, judgment, and broken trust. One young person shared that when they went to ask for contraceptives, a nurse told their parents. Experiences like this push many adolescents away from formal health services, leading to lower contraceptive use, unwanted pregnancies, and higher STI rates.
Here’s the thing: these young people aren’t avoiding healthcare. They’re avoiding experiences that feel unsafe, humiliating, or disrespectful. Their avoidance isn’t irresponsibility; it’s a rational response to systems that fail to guarantee safety, dignity, and trust. So, before we blame youth, maybe we should ask: what about the system is failing them?
When “Youth-Friendly” Feels Like Anything But Friendly
Youth-friendly services often look good on paper but fail in reality. They’re treated as a label rather than a standard, one that actually holds providers accountable for how they treat young people. True accountability is intersectional. A system isn’t really friendly if it leaves youth navigating the added layers of poverty, disability, or marginalized gender and sexual identities feeling unsafe. We need to move from a “one-size-fits-all” youth label to a system that protects the most vulnerable among us.
I’ve seen young people hesitate at clinic doors, not because they don’t care about their health, but because they’ve heard stories or experienced judgment and dismissal. And research backs this up: adolescents across countries avoid clinics because of judgmental attitudes, breaches of confidentiality, and dismissive interactions (Systematic Review, 2020; BMC Health Services Research, 2023; Reproductive Health, 2025). In Rwanda, Nigeria, and Ghana, it’s the same story. Disengagement isn’t random; it’s predictable when systems prioritize adult authority over youth trust. When clinics reward judgment over empathy, avoidance isn’t rebellion; it’s logic.
Betrayed Before They Even Enter: Why Confidentiality Is Everything
Confidentiality is the most underestimated barrier to youth engagement. I’ve seen adolescents literally stop mid-conversation, afraid their privacy won’t be respected. They’d rather ask friends than risk exposure. Studies confirm this: in Tanzania, 77% of adolescents cited lack of privacy as a reason for avoiding reproductive health services (Lutende, 2020).
This isn’t just about numbers. It’s a signal of systemic failure. Optional privacy communicates that adolescents’ autonomy is secondary. The predictable result? Young people turn to peers or social media, sometimes getting misinformed. And from a systems-thinking lens? This isn’t a personal failing; it’s a design flaw.
And now, in a digital age, confidentiality isn’t just about a nurse talking to a parent. It’s about fear that your digital health footprint could be tracked, sold, or exposed. We need ‘Digital Safe Havens’ where anonymity is guaranteed by the architecture of the system itself, not by hope.
Gen Z Isn’t Disengaged — They’re Distrustful
Gen Z grew up in a world of instant information, global crises, and constant awareness of institutional failures. They’re digitally literate, globally aware, and quick to challenge authority. Yet, they often rely on peers or online communities for health guidance, even when it risks misinformation. Their distrust of health systems isn’t innate; it’s learned. Every dismissive interaction, every judgmental comment teaches them that the system can’t be trusted.
Why would anyone trust a system that consistently signals judgment, betrayal, and dismissal? It’s not apathy, it’s rational avoidance. And as a future health leader, this tells me one thing: our systems need a redesign, not cosmetic policy tweaks.
The System We Built Is the One We’re Complaining About
Systems thinking reminds us: the design determines the outcome. If we want adolescents to engage, the system itself has to change. That means shifting the mental model from the “Moral Guardian,” where providers judge youth behavior, to a “Partnership Model,” where adolescent autonomy is fundamental. True youth-friendly services aren’t about signs or slogans; they’re about co-design, empathy-centered hours, safe spaces, and real accountability.
Imagine clinics co-designed with youth: confidentiality isn’t optional, mental and reproductive health are integrated, and decisions reflect youth priorities. Leadership has to ask: what about this system makes youth feel unsafe? Are policies and incentives reinforcing judgment over trust? Asking these questions is far more productive than blaming adolescents for walking away.
Walking Away Isn’t Rejection, It’s a Message
When Gen Z walks away, they’re not rejecting care; they’re sending a message. “They will not go to spaces that make them feel unsafe, judged, or disrespected.”
As someone starting my journey as a global health leader, this is a wake-up call. Solutions aren’t only policy-driven; without trust, even the best policies fail. Gen Z isn’t the problem. Their avoidance is a signal. Emerging leaders, and all of us reading this, must listen. The real question is: what kind of health system do we want for the next generation, and what are we willing to change to make it real?
To health leaders, practitioners, and advocates: don’t wait for disengagement to force change. Listen to youth, involve them in designing services, and make trust, confidentiality, and respect the pillars of care. Every conversation, every policy review, every outreach session is an opportunity to build a system that youth actually want to engage with. Let’s not just provide services; let’s design experiences that make healthcare a place they choose, every time.
REFERENCES
Jones, R. K., Boonstra, H., & Frost, J. J. (2018). Adolescents’ and young adults’ reports of barriers to confidential health care and receipt of contraceptive services. Journal of Adolescent Health, 62(1), 36–43. https://doi.org/10.1016/j.jadohealth.2017.10.011
Lutende, L. (2020). Perceptions of adolescent reproductive health services in Tanzania (Master’s thesis). Open University of Tanzania. https://repository.out.ac.tz/1820/
Systematic review of adolescents’ and providers’ views on access and use of sexual and reproductive health services. (2020). PubMed. https://pubmed.ncbi.nlm.nih.gov/31433601/
BMC Health Services Research. (2023). Barriers to and facilitators of youth-friendly health services programmes in Rwanda. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-023-10526-3
BMC Public Health. (2025). Exploring factors constraining utilization of contraceptive services among adolescents in Southeast Nigeria. https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-025-02010-4
Guttmacher Institute. (n.d.). The sexual and reproductive health needs of very young adolescents. https://guttmacher.org/sites/default/files/report_pdf/srh-needs-very-young-adolescents-report_0.pdf?utm
National guidelines for the provision of adolescent and youth-friendly services in Kenya. (2016). Ministry of Health, Kenya. https://prb.org/wp-content/uploads/2018/05/National-Guidelines-for-Provision-of-Adolescent-and-Youth-Friendly-Services-in-Kenya-2016.pdf?utm