Uncovering and responding to needs for sexual and reproductive health care among poor urban female adolescents in Nicaragua

Abstract

Summarybackground To meet the needs of female adolescents from low-income urban areas for sexual and reproductive health (SRH) care, vouchers providing free-of-charge access to SRH care at 19 primary care clinics were distributed in Managua, Nicaragua. These vouchers substantially increased the use of services, demonstrating that many adolescents are willing to use such services, if readily accessible. The voucher redemption made it possible to identify the nature of existing, but largely unmet, needs for SRH care.method The medical files from 3301 consultations with female adolescents were analysed using descriptive statistical methods and multiple logistic regression.results Female adolescents presented SRH problems that merited medical attention. The mean number of problems presented was 1.5 per consultation: 34% of the vouchers were used for contraceptives, 31% for complaints related to sexually transmitted infection (STI) or reproductive tract infection (RTI), 28% for advice/counselling, 28% for antenatal check-up and 18% for pregnancy testing. A new category of health care users emerged: sexually active girls who were neither pregnant nor mothers and who sought contraceptives or STI/RTI treatment. Contraceptive use doubled among the sexually active non-pregnant voucher redeemers. Consultation with a female doctor younger than 36 years was associated with a higher chance of having contraceptives prescribed.conclusion Accessible and appropriate SRH care has the potential to make an important contribution to the increased contraceptive use, decreased risk of unwanted teenage pregnancies and decreased prevalence of STIs/RTIs among underserved adolescents. Once adolescents access the services, providers have a crucial role in ensuring current and continuing needs are met.keywords adolescents, Nicaragua, sexual and reproductive health care, unmet needs, voucher programme, access to care

Knowledge and Awareness of Human Papillomavirus (HPV), Cervical Cancer and HPV Vaccine among Women in Two Distinct Nepali Communities

“…About a quarter of adolescent females who took part in a health care voucher program in Nicaragua used their voucher to seek reproductive health care counseling (Meuwissen et al, 2006). In Kenya, a network of over 200 reproductive health care providers called the "Kisumu Medical Education Trust" found individuals who accessed their services used family planning counseling and Derek Christopher Johnson et al contraception counseling more often than individuals who did not access their services (Decker and Montagu, 2007).…”

Incentivizing HIV/STI Testing: A Systematic Review of the Literature

“…Vouchers, however, have been used to promote attendance at sexual risk behavior reduction sessions [38, 39] and general sexual and reproductive health services [40]. No studies were found that measured STI testing uptake rate outcomes.…”

Emergency Contraceptive Pills: Knowledge and Attitudes Of Pharmacy Personnel in Managua, Nicaragua

“…21 Pharmacies also offer an informal atmosphere in which women can obtain drugs and private health care counseling without revealing their identity 21 and are preferred by girls who do not yet have children. 9 According to Meuwissen et al, the majority (63%) of sexually active 11-20-year-old females in Nicaragua who are not mothers prefer to purchase their modern contraceptives in pharmacies, whereas public health services are the most common supplier of contraceptives among females who already have children (76%). 9 Although both public health services and private pharmacies serve important functions by helping women avoid unintended pregnancy, pharmacies are especially likely to meet the needs of female adolescents, who face the highest risk of unintended pregnancy, by giving them quality reproductive health care counseling and emergency contraceptive pills.…”

“…8 In 2006, almost half of sexually active young women in Managua who were not pregnant and had no children had never used a contraceptive method. 9 Third, Nicaragua bans abortion. In 2006, it became one of the few countries in the world where abortion is illegal even in cases of rape or a pregnancy threatening the woman's life.…”