{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T12:14:47Z","timestamp":1790079287994,"version":"4.0.1"},"reference-count":35,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Developing World Bioethics"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Disparities in adolescent sexual and reproductive health (SRH) access in rural Uganda are commonly attributed to geographic distance, resource scarcity, and service availability. These explanations, while important, remain ethically incomplete unless they also account for duty: the social and economic responsibilities that constrain adolescents\u2019 capacity to prioritise health needs. Drawing on empirical findings from a study of 408 adolescents aged 13\u201319 years in the Bugweri and Iganga districts of eastern Uganda, this paper integrates Rawlsian distributive justice and the capability approach to examine how distance, disparity, and duty interact to undermine adolescent reproductive agency. Structural equation modelling shows that positive health\u2010seeking attitudes strongly predict anticipated future SRH utilisation; however, this relationship is attenuated among adolescents engaged in paid or subsistence work. Justice\u2010oriented SRH policy must recognise duty as a structural moral burden and design work\u2010sensitive interventions, such as mobile outreach and weekend clinics, that protect adolescents\u2019 capability for reproductive agency.<\/jats:p>","DOI":"10.1111\/dewb.70062","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:49:25Z","timestamp":1790077765000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Distance, Disparity, and Duty: An Empirical Bioethical Analysis of Adolescent Sexual and Reproductive Health Access in Rural Uganda"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6342-4113","authenticated-orcid":false,"given":"Noah","family":"Nyende","sequence":"first","affiliation":[{"name":"Nkumba University Entebbe Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2023.1287625","article-title":"Editorial: Adolescent Sexual and Reproductive Health Challenges in Low\u2010Income Settings","volume":"11","author":"Alam N.","year":"2023","journal-title":"Frontiers in Public Health"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"45","DOI":"10.2147\/AHMT.S455517","article-title":"Exploring Barriers to Accessing Adolescents Sexual and Reproductive Health Services in South Ethiopia Regional State: A Phenomenological Study Using Levesque's Framework","volume":"15","author":"Sidamo N.","year":"2024","journal-title":"Adolescent Health, Medicine and Therapeutics"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","unstructured":"J. N.Bukenya T.Ssekamatte R.Komuhendo et al. Young People's Access to Sexual and Reproductive Health Services in Uganda: Understanding Barriers and Facilitators. (Research Report Guttmacher Institute 2025).","DOI":"10.1363\/2025.300621"},{"key":"e_1_2_11_5_1","volume-title":"Lost Opportunity? 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