Servicios Amigables: Provider perspectives on youth-friendly sexual and reproductive health services in Mexico Open Access

Bravo, Lilian (2015)

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Background: Mexico has a high adolescent pregnancy rate of 69.5 births per 1,000 adolescent women. Adolescent pregnancy has negative consequences for both the mother and the child. Given that Mexico's adolescent population makes up 20.2% of the population, new programs have been implemented at the national level to address the growing adolescent pregnancy issue.

Objective: To understand to what extent providers adhere to youth friendly services (YFS) and identify barriers to the provision of youth friendly services. This analysis also aimed to provide recommendations for future sexual and reproductive health (SRH) programming for adolescents in Mexico.

Methods: Qualitative interview data from a cross-sectional study conducted in 2012 through a partnership between the National Institute of Public Health (INSP) and the National Institute for Women (INMUJERES) was analyzed for this project. Fifteen interviews with health providers who worked in public health institutions with experience providing services to adolescents were analyzed using MaxQDA V.11 software. Thematic analysis was conducted to identify and describe prominent themes within the interviews.

Results: The majority of providers were familiar with the tenets of YFS. Four fifths of providers interviewed expressed a desire for more training regarding adolescent health. At the same time, several providers had not internalized the national goal of providing information and tools to adolescents equally between genders and age. Providers also frequently mentioned negative parental attitudes that impede the provision of SRH services.

Discussion: While it is desirable to implement youth friendly services in clinical settings, there is little evidence that this approach alone changes adolescent risk behavior. Adopting evidence-based programming will be a better solution to reducing adolescent pregnancy rates, particularly interventions that target parents as well as adolescents. Introducing continuous training for health providers will be beneficial to promote confidence, patient retention and satisfaction, as well as reducing the impact of conservative views on practice.

Table of Contents

Chapter 1: Introduction. 1

Problem Statement. 2

Purpose Statement. 2

Research Questions. 2

Significance Statement. 3

Chapter 2: Literature Review. 4

Servicios Amigables - Youth Friendly Services. 4

Youth Friendly Services in Latin America. 6

Current State of Adolescent Health in Mexico. 9

Efforts to Improve Adolescent Health in Mexico. 12

Critiques of YFS and Gap in the Literature. 16

Chapter 3: Methods. 18

Setting. 18

Research Design and Procedures. 19

Data Analysis. 19

Ethical Considerations. 20

Chapter 4: Results. 21

Education in the Clinical Setting. 25

Public Health Impact of Adolescent Health. 27

Education Through School Partnerships. 28

Barriers to Youth Friendly Services. 28

Conservative Views. 28

Institutional Barriers. 31

Chapter 5: Discussion. 35

Recommendations. 37

Training. 37

Parental involvement 39

Evidence Based Interventions. 40

Strengths and Limitations. 42

Public Health Implications. 43

Appendix. 44

Appendix 1: Spanish Interview Guide. 44

Appendix 2: Qualitative Interview Guide for Health Care Providers [English Version]. 48

Appendix 3: Finalized Adolescent Sexual and Reproductive Health Codebook. 52

References. 53

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