Proceso de implementación de una iniciativa de atención a mujeres en postaborto en Chile, 2016-2020 / The implementation process of a post-abortion healthcare initiative in Chile, 2016-2020

Objetivo: Analizar el proceso de implementación de una iniciativa de calidad de atención en el postaborto en tres hospitales de Santiago de Chile para su posterior escalamiento al ámbito nacional. Método: Se efectuó un estudio cualitativo, con base en una revisión documental sustentada en documentos normativos emitidos por el Ministerio de Salud y 23 entrevistas semiestructuradas a tomadores de decisiones, profesionales de salud y usuarias. Se realizó un análisis de contenido usando el programa Atlas-ti 8. Resultados: A nivel normativo, se identificaron acciones relacionadas con la implementación de la iniciativa, y a nivel de proceso se identificaron los aciertos, las dificultades y las resistencias que experimentaron los equipos involucrados en el piloto durante su implementación. A pesar de que la implementación de la iniciativa no fue planificada, tuvo efectos positivos para el bienestar de las mujeres y el desempeño de los profesionales de atención implicados en el proceso. Conclusiones: Esta experiencia es un punto de partida para planear la implementación nacional con base en estrategias bien definidas. Los resultados aportan una experiencia documentada para quienes desean desarrollar iniciativas o programas de atención a mujeres en situación de postaborto.

Objective: To analyze the implementation process of a quality post-abortion care initiative in three hospitals in Santiago de Chile for its subsequent scale up at the national level. Method: A qualitative study was carried out, based on a documentary review supported by governmental normative documents issued by the Ministry of Health and 23 semi-structured interviews with decision-makers, health providers and users. Content analysis was performed using the Atlas-ti 8 software. Results: At the regulatory level, actions related to the implementation of the initiative were identified, and at the process level, the success, difficulties and resistance experienced by the teams involved in the pilot during its implementation were identified. Although the implementation of the initiative was not planned, it had positive effects on the well-being of the women and the performance of the care providers involved in the process. Conclusions: This experience is a starting point to plan implementation at the national level with well-defined strategies. Our results provide a documented experience for those who wish to develop post-abortion care initiatives or programs.

Sexual and reproductive health among adolescents in vulnerable contexts in Mexico: Needs, knowledge, and rights.

Ensuring sexual and reproductive health, and rights for adolescents entails the prevention of early pregnancies, which are widely recognized as a public health problem. Based on the ecological model for early pregnancy, this article identifies the healthcare requirements for preventing unintended adolescent pregnancies in predominantly indigenous communities in Chiapas, Mexico. Using a convergent parallel mixed-methods study design, we surveyed adolescents (12-15 years old) and health personnel, organized focus groups with adolescents and their parents, and conducted in-depth interviews at the individual, family, school and community levels. Results showed that adolescents recognized their right to receive sexuality education (64.5%) as well as information on contraceptive methods (53.0%), with indigenous language speakers and individuals living in overcrowded households less likely to know about these rights. Parents of adolescents knew little about contraception and pregnancy. School teachers lacked necessary tools for offering comprehensive sexuality education. A traditional, patriarchal perspective predominated among participants, fostering gender inequalities. In conclusion, it is essential to implement multifocal strategies under a human-rights, intercultural, and health-equity approach. Special attention should be directed to the spheres in which adolescents interact, and efforts should focus on improving knowledge, empowering adolescents, and enhancing their access to sexual and reproductive health resources.

Public policy on the prevention of subsequent adolescent pregnancy: what type of policy prevails?

This study aims to conduct a search of public-policy instruments seeking explicit references to subsequent adolescent pregnancy, as well as to discern what kinds of actions have been proposed as part of the international and national agendas to facilitate subsequent adolescent pregnancy prevention and care. During June 2021, we used an integrative review to search and to analyze national and international public policy instruments along with other documents related to subsequent adolescent pregnancy. We observed, for each, the presence of statements on subsequent adolescent pregnancy. The research team was then divided into triads to discuss and to classify each reference under one of the following categories: (a) a symbolic statement, that is, an intention not implying a specific action but rather presenting a vision for the future; (b) a substantive-material statement concerning an action intended to solve a problem; and (c) a procedural-material statement indicating specific actions, processes, budgets, and actors. We analyzed a total of 135 public-policy documents: 102 in Mexico and 33 internationally. Only four national and six international documents contained either symbolic or substantive-material references to the subject of interest and only one specified a procedural-material statement. The prevention and care of subsequent adolescent pregnancy are addressed only secondarily on the public agendas. Only a minimal number of actions comprise specific and standardized measures to prevent subsequent adolescent pregnancy according to the different actors involved. Designing a greater number of procedural-material policies will help to reduce morbidity and mortality in the mother-child binomial and promote a comprehensive development of this population.

Anticoncepción posevento obstétrico y embarazo subsecuente en adolescentes: perspectivas del personal de salud en México.

OBJETIVO: Identificar cómo se implementa la estrategia de anticoncepción posevento obstétrico (APEO) y analizar las barreras, acciones y recomendaciones para prevenir embara-zos subsecuentes en adolescentes. Material y métodos. Estudio cualitativo a través de análisis de contenido de 21 en-trevistas semiestructuradas a personal de salud de instituciones de atención a población sin seguridad social de la Ciudad de México y Morelos. RESULTADOS: La APEO se promueve du-rante el embarazo, parto, posaborto, puerperio y hasta 12 me-ses después del evento obstétrico. La consejería debe abordar, además de información técnica sobre métodos anticonceptivos, otras temáticas clave en relación con los derechos sexuales y reproductivos de los adolescentes. Se identifican barreras personales, institucionales y sociales para la implementación de la estrategia; el personal refiere acciones y recomendaciones específicas para su consolidación. Conclusión. La estrategia de APEO se debe fortalecer para garantizar la oferta de un servicio acorde con las necesidades de las mujeres menores de 20 años, así como diseñar intervenciones basadas en las buenas prácticas y recomendaciones de los prestadores de salud para superar las barreras y lograr periodos intergenésicos más allá de la adolescencia.

Severe Adverse Maternal and Neonatal Outcomes in Adolescent Mother-Newborn Dyads: A Multicentre Study in Latin America.

OBJECTIVES: To compare the risk of severe adverse maternal outcomes (SMO) and neonatal outcomes (SNO) and analyse their maternal correlates in adolescent mother-newborn and young mother-newborn dyads in secondary and tertiary care users in Latin America. METHODS: We performed a secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health database in 83 secondary and tertiary hospitals in seven countries in Latin America. We constructed a composite indicator of both SMO and SNO and estimated odds ratios (OR) comparing adolescent mothers (aged 12-19) with young mothers (aged 20-24). Our unit of analysis was the mother-newborn dyad. RESULTS: We found that the combination of SMO and SNO was three times more likely in adolescent mother as compared to young mother dyads (OR 3.56; 95% CI 1.67-7.59). SNO either alone or in combination with SMO were more likely in adolescents aged 12 to 16 than in young women (OR 1.27 and 4.87, respectively). CONCLUSIONS FOR PRACTICE: Adolescent mothers and their newborns are at an increased risk of severe adverse outcomes during child birth and in the first week postpartum compared to young mother dyads, especially young adolescents. Focusing on the dyad as a whole may facilitate a step towards integrated care which maximizes the health benefits of both mother and newborn. Continued efforts are needed to improve health care and prevention initiatives directed towards adolescent women and their newborns in Latin America.

Public policy on the prevention of subsequent adolescent pregnancy: what type of policy prevails? / Políticas públicas para la prevención de embarazos subsecuentes en adolescentes: ¿qué tipo de política prevalece? / Políticas públicas de prevenção de gestações sucessivas na adolescência: que tipo de política prevalece?

This study aims to conduct a search of public-policy instruments seeking explicit references to subsequent adolescent pregnancy, as well as to discern what kinds of actions have been proposed as part of the international and national agendas to facilitate subsequent adolescent pregnancy prevention and care. During June 2021, we used an integrative review to search and to analyze national and international public policy instruments along with other documents related to subsequent adolescent pregnancy. We observed, for each, the presence of statements on subsequent adolescent pregnancy. The research team was then divided into triads to discuss and to classify each reference under one of the following categories: (a) a symbolic statement, that is, an intention not implying a specific action but rather presenting a vision for the future; (b) a substantive-material statement concerning an action intended to solve a problem; and (c) a procedural-material statement indicating specific actions, processes, budgets, and actors. We analyzed a total of 135 public-policy documents: 102 in Mexico and 33 internationally. Only four national and six international documents contained either symbolic or substantive-material references to the subject of interest and only one specified a procedural-material statement. The prevention and care of subsequent adolescent pregnancy are addressed only secondarily on the public agendas. Only a minimal number of actions comprise specific and standardized measures to prevent subsequent adolescent pregnancy according to the different actors involved. Designing a greater number of procedural-material policies will help to reduce morbidity and mortality in the mother-child binomial and promote a comprehensive development of this population.

El objetivo de este estudio fue realizar una búsqueda de instrumentos de políticas públicas que hagan referencia explícita a los embarazos subsecuentes en adolescentes, así como distinguir qué tipo de acciones forman parte de las agendas internacionales y nacionales para su prevención y atención. Durante el mes de junio de 2021, realizamos una revisión integradora para buscar y analizar instrumentos de políticas públicas nacionales e internacionales, junto con otros documentos relacionados a los embarazos subsecuentes en adolescentes. Para cada uno, registramos la presencia de declaraciones sobre embarazos subsecuentes en adolescentes. El equipo de investigación se dividió en tríadas para discutir y clasificar cada referencia en una de las siguientes categorías: (a) declaración simbólica, es decir, intención que no implica una acción específica, sino una visión hacia el futuro; (b) declaración material-sustantiva, hace referencia a una acción enfocada en resolver un problema; y (c) declaración material-procedimental, indica acciones, procedimientos, presupuestos y actores específicos. En total se analizaron 135 documentos de políticas públicas: 102 de México y 33 a nivel internacional. Solamente cuatro documentos nacionales y seis internacionales contenían referencias simbólicas o materiales sobre el tema de interés, únicamente uno refirió una declaración material-procedimental. La prevención y la atención de embarazos subsecuentes en adolescentes son temas secundarios en las agendas públicas. Pocas son las acciones que comprenden medidas específicas y estandarizadas para prevenir los embarazos subsecuentes en adolescentes de acuerdo con los diferentes actores involucrados. La elaboración de más políticas procedimentales y sustantivas contribuirá a una reducción de la morbimortalidad en el binomio madre-hijo y a una promoción del desarrollo integral de este grupo poblacional.

O objetivo foi realizar uma busca de instrumentos de políticas públicas que busquem referências explícitas a gestações sucessivas na adolescência, bem como discernir que tipos de ações têm sido propostas como parte das agendas internacionais e nacionais para facilitar sua prevenção e cuidado. Durante junho de 2021, utilizamos uma revisão integrativa para pesquisar e analisar instrumentos de políticas públicas nacionais e internacionais, juntamente com outros documentos relacionados a gestações sucessivas na adolescência. Para cada um, registramos a presença de declarações sobre gestações sucessivas na adolescência. A equipe de pesquisa então se dividiu em tríades para discutir e classificar cada referência sob uma das seguintes categorias: (a) uma declaração simbólica, ou seja, uma intenção sem implicação de uma ação específica, mas uma apresentação de visão para o futuro; (b) uma declaração substantiva sobre uma ação destinada a resolver um problema; e (c) uma declaração processual-material indicando ações, processos, orçamentos e atores específicos. Foram analisados um total de 135 documentos de políticas públicas: 102 no México e 33 internacionalmente. Apenas quatro documentos mexicanos e seis internacionais continham referências simbólicas ou substantivas ao tema de interesse e apenas um especificava uma declaração processual-material. A prevenção e o cuidado de gestações sucessivas na adolescência são abordados como secundários nas agendas públicas. Apenas um número mínimo de ações compreende medidas específicas e padronizadas para prevenir gestações sucessivas na adolescência de acordo com os diferentes atores envolvidos. A elaboração de um maior número de políticas processual-material ajudará a reduzir a morbidade e a mortalidade no binômio mãe-filho e promover um desenvolvimento abrangente desse grupo populacional.

A Rapid Review of Interventions to Prevent First Pregnancy among Adolescents and Its Applicability to Latin America.

STUDY OBJECTIVE: To summarize recent literature on the effectiveness of interventions to prevent adolescent pregnancy and to explore the applicability of these interventions to Latin America (LA). Design, Setting, Participants, Interventions, and Main Outcome Measures: We carried out a rapid review of the literature (2005-2019). Studies were included if: they evaluated interventions targeting adolescents and prevention of pregnancy; they used a randomized controlled design; and pregnancy was measured as an outcome. Applicability of the interventions to LA was assessed using the following information: target population; intervention design and resources; type, skills, and training of providers; system arrangements; and acceptability and social context. RESULTS: Nine studies were included, 5 described interventions in African countries, 2 in the United Kingdom, and 2 in the United States. Interventions were rated as highly applicable to LA in the context of target population, profile of the providers, and design; however, variations arose when assessing system arrangements and social context. Incentive-based interventions showed significant effects in the prevention of adolescent pregnancy and were rated as highly applicable. CONCLUSION: This review provides professionals, policymakers, researchers, and educators potential criteria to consider when adapting successful evidence-based interventions to prevent adolescent pregnancy in LA.

"I Matter, I Learn, I Decide": An Impact Evaluation on Knowledge, Attitudes, and Rights to Prevent Adolescent Pregnancy.

Adolescent pregnancy is considered a priority public health issue because of its implications in the lives of young mothers, their children, and the well-being of the general population. In this paper, we describe an intervention targeting adolescents (aged 11-19 years old) in a rural context and estimate its impact on key outcomes relevant to early pregnancy prevention: knowledge and self-efficacy concerning sexual and reproductive health, knowledge of sexual and reproductive rights, and attitudes toward gender roles. Our study used a quasi-experimental design comprising 747 adolescents. Three difference-in-differences models (raw, adjusted, and by exposure level) with fixed effects estimated the changes in all outcome measures. Our results showed that the intervention community had a significant improvement in all outcomes, and this improvement was larger in those who received the highest-exposure level of intervention compared to a control community. Our study provides evidence that a community-based intervention, founded on comprehensive sexual education, is a promising approach to improve key outcomes related to early pregnancy in rural contexts. Further research should be undertaken to test how similar strategies focusing on multi-layer early pregnancy determinants work on other sub-groups of vulnerable adolescents, such as school dropouts or those living in disadvantaged circumstances.

Lot quality assurance sampling: Information provided to female users of contraceptive methods regarding side effects.

Women need to receive accurate information on the proper use of contraceptive methods (CM). The objective of our analysis was to evaluate the quality of CM counseling in health institutions of the public sector using the Lot Quality Assurance Sampling (LQAS) technique. We specifically analyzed whether health-service providers informed CM users of all the side effects they might experience, as specified under the Mexican health-care regulations. Our results demonstrated that, among the four CM analyzed -the intrauterine device, hormonal injection, condom and subdermal implant- only the users of the subdermal implant received complete information on side effects. Our findings thus indicate that the quality of family planning services in the institutions analyzed is deficient. We recommend that service providers be regularly trained in order to improve their performance and that LQAS methodology be adopted as an effective means of regularly monitoring the quality of health services in Mexico.

Evaluación de procesos de una intervención: actividad física durante el embarazo y postparto / Avaliação dos processos de uma intervenção: atividade física durante a gravidez e o pós-parto / Evaluation of intervention processes: physical activity during pregnancy and postpartum

Objetivo: Evaluar los procesos de una intervención de actividad física durante el embarazo y postparto. Métodos: En el contexto de un programa social que combate la pobreza extrema, las beneficiarias (n=927) recibieron una intervención que consistió en la promoción de la práctica de actividad física, a través de consejería, talleres y materiales educativos. En 2008-9, 2010 y 2012 se visitaron unidades de salud urbanas y rurales, seleccionadas aleatoriamente, de cuatro entidades federativas de México. Se recolectó información de procesos a través de prestadores de servicios de salud, observación en consulta y aplicación de encuestas de salida a beneficiarias. Se estudiaron cuatro indicadores de implementación de la intervención: fidelidad a actividades planeadas; dosis entregada a la población; alcance de la población objetivo; y recepción de la intervención por embarazadas y en el posparto de las participantes. Resultados: Se visitaron unidades de salud en la etapa inicial (n=91), intermedia (n=47) y final (n=82) del estudio. La dosis liberada presentó un nivel del 81-86% de implementación. La fidelidad presentó <50% de implementación; se observaron mejoras significativas en la mayoría de los aspectos evaluados entre las diferentes etapas del estudio como en la capacitación de los prestadores de servicios de salud, el suministro de materiales, la consejería e la impartición de talleres en las unidades de salud. Conclusión: Se observaron importantes retos de implementación y contextuales para la implementación efectiva de la intervención de actividad física en los servicios de salud.

Objetivo: Avaliar os processos de uma intervenção de atividade física durante a gravidez e o pós-parto. Métodos: No contexto de um programa social de combate à pobreza extrema, as beneficiárias (n=927) receberam uma intervenção que consistia na promoção da prática de atividade física por meio de aconselhamento, oficinas e materiais educacionais. Em 2008-9, 2010 e 2012, foram visitadas unidades de saúde urbanas e rurais, selecionadas aleatoriamente, de quatro entidades federais do México. As informações do processo foram coletadas por prestadores de serviços de saúde, durante observação de consultas e através da aplicação de questionários às beneficiárias. Foram estudados quatro indicadores de implementação da intervenção: fidelidade às atividades planejadas, dose entregue à população, escopo da população-alvo, e acolhimento da intervenção por gestantes e puérperas. Resultados: As unidades de saúde foram visitadas nas etapas inicial (n = 91), intermediária (n = 47) e final (n = 82) do estudo. A dose liberada mostrou um nível de implementação de 81-86%. A fidelidade apresentou <50% de implementação e melhorias significativas foram observadas na maioria dos aspectos avaliados entre as diferentes etapas do estudo, como treinamento de prestadores de serviços de saúde, fornecimento de materiais, aconselhamento e realização de oficinas nas unidades de saúde. Conclusão: Importantes implementações e desafios contextuais foram observados para a efetiva implementação da intervenção de atividade física para beneficiárias dos serviços de saúde investigados.

Objective: To evaluate the process of an intervention on physical activity during pregnancy and postpartum. Methods: In the context of a social program that fights extreme poverty, the beneficiaries (n=927) receive an intervention that consists of the promotion of the practice of physical activity, through counseling, workshops, and educational materials. During 2008-9, 2010 and 2012, we visited health units from urban and rural areas, randomly selected from four states of Mexico. Health service providers collected process data during observation of consultations and through the application of questionnaires to the beneficiaries. Four indicators of implementation of the intervention were studied: fidelity to the planned activities, dose delivered to the population, scope of the target population, and reception of the intervention by pregnant women and postpartum women. Results: Health units were visited in the initial (n=91), intermediate (n=47), and final (n=82) stages of the study. The delivered dose showed an implementation level of 81-86%. Fidelity had <50% implementation and significant improvements were observed in most analyzed aspects between the different stages of the study, such as training of health service providers, the supply of materials, counseling, and workshops in health units. Conclusion: Important Implementation and contextual challenges were observed for the effective fulfillment of the intervention of physical activity into primary healthcare services.

Frequency of ubiquitous connectivity and associated factors among Mexican adolescents.

BACKGROUND: There is limited information in Mexico - a middle-income country and a digital adopter with an important demographic bonus - regarding the potential use of technology and connectivity in health promotion among adolescent population. Therefore, the objective of this study was to determine the proportion of adolescents connected ubiquitously; and to identify its associated factors for the further development of mobile health interventions. METHODS: An online survey of adolescents from state of Morelos, Mexico, was conducted in 2016. Explored individual socio-educational and school technological infrastructure characteristics and habits of use of mobile technologies. A logistic regression model was fitted to identify variables associated with ubiquitous connectivity. RESULTS: One thousand three hundred thirty-six students were included and six questionnaires (0.45%) were eliminated due to duplication of information. Fifty-four percent of participants were female, and the mean age was 16.31 ± 0.84 years. In total, 47% of students were ubiquitously connected. Associated factors to ubiquitous connectivity included better academic performance, the need to use Internet-based technologies, engaging in ludic activities on the Web and living in the state capital. CONCLUSIONS: Ubiquitous connectivity it's a desirable condition for strengthening health promotion programs focused on young population. Strategies including digital technology tools with potential to increase adolescent engagement should be explored and evaluated. However, it is necessary to recognize that there are additional factors that may influence the success of health promotion interventions.

Intervention for the comprehension of menstrual cycle, body function and pregnancy in adolescents from rural context.

OBJECTIVE: To measure the impact of an intervention on adolescents' knowledge of the phase of the menstrual cycle with more likelihood of pregnancy and identify its associated factors. MATERIALS AND METHODS: A quasi-experimental study in two rural communities. Difference-in-differences analyses was performed. RESULTS: There was a 22.1% average reduction in wrong answers on the phase of the menstrual cycle with more likelihood of pregnancy in the intervention group versus the control group (p<0.001). We founded six factors associated with this knowledge: marry and have children, right to receive education and information on sexual and reproductive health; gender equity; use of the condom; condom self-efficacy; emergency and contraceptive pills. CONCLUSIONS: There is a prevailing need to improve -among sexuality topics- basic knowledge of reproductive biology, while at the same time insisting on the benefits of using birth control methods provided for practicing responsible sexuality.

OBJETIVO: Medir el efecto de una intervención en el conocimiento de los adolescentes sobre la fase del ciclo menstrual de mayor posibilidad de embarazo e identificar sus factores asociados. MATERIAL Y MÉTODOS: Estudio cuasiexperimental en comunidades rurales. Se realizó un análisis de diferencias en diferencias. RESULTADOS: Hubo una reducción promedio de 22.1% de respuestas incorrectas sobre la fase del ciclo menstrual de mayor posibilidad de embarazo en el grupo intervención vs. control (p<0.001). Se encontraron seis factores asociados con este conocimiento: casarse y tener hijos; derecho a recibir educación e información sobre salud sexual y reproductiva; equidad de género; uso correcto del condón; autoeficacia del uso del condón y pastillas anticonceptivas y de emergencia. CONCLUSIONES: Entre las diferentes temáticas de sexualidad, prevalece la necesidad de mejorar los conocimientos básicos sobre biología de la reproducción, insistiendo a la vez sobre los beneficios que conlleva el uso de métodos anticonceptivos para ejercer una sexualidad responsable.

Intervention for the comprehension of menstrual cycle, body function and pregnancy in adolescents from rural context / Intervención para comprender el ciclo menstrual, funcionamiento del cuerpo y embarazo en adolescentes de contexto rural

Abstract: Objective: To measure the impact of an intervention on adolescents' knowledge of the phase of the menstrual cycle with more likelihood of pregnancy and identify its associated factors. Materials and methods: A quasi-experimental study in two rural communities. Difference-in-differences analyses was performed. Results: There was a 22.1% average reduction in wrong answers on the phase of the menstrual cycle with more likelihood of pregnancy in the intervention group versus the control group (p<0.001). We founded six factors associated with this knowledge: marry and have children, right to receive education and information on sexual and reproductive health; gender equity; use of the condom; condom self-efficacy; emergency and contraceptive pills. Conclusion: There is a prevailing need to improve -among sexuality topics- basic knowledge of reproductive biology, while at the same time insisting on the benefits of using birth control methods provided for practicing responsible sexuality.

Resumen: Objetivo: Medir el efecto de una intervención en el conocimiento de los adolescentes sobre la fase del ciclo menstrual de mayor posibilidad de embarazo e identificar sus factores asociados. Material y métodos: Estudio cuasiexperimental en comunidades rurales. Se realizó un análisis de diferencias en diferencias. Resultados: Hubo una reducción promedio de 22.1% de respuestas incorrectas sobre la fase del ciclo menstrual de mayor posibilidad de embarazo en el grupo intervención vs. control (p<0.001). Se encontraron seis factores asociados con este conocimiento: casarse y tener hijos; derecho a recibir educación e información sobre salud sexual y reproductiva; equidad de género; uso correcto del condón; autoeficacia del uso del condón y pastillas anticonceptivas y de emergencia. Conclusión: Entre las diferentes temáticas de sexualidad, prevalece la necesidad de mejorar los conocimientos básicos sobre biología de la reproducción, insistiendo a la vez sobre los beneficios que conlleva el uso de métodos anticonceptivos para ejercer una sexualidad responsable.

Overall user satisfaction with family planning services and associated quality care factors: a cross-sectional analysis.

BACKGROUND: Studies of user satisfaction with family planning services (FPSs) have been conducted in different countries, and have been employed to identify ways of improving health, reducing costs and implementing reforms. The present work is the first-ever study undertaken in Mexico on the subject. Our objective was to identify how overall user satisfaction with FPSs in Mexico was related to: healthcare logistics, the functional value of services and the quality of interpersonal relations. METHODS: Users of 18 public clinics were surveyed in 2015. Data collected referred to their past and present use of FPSs, as well as to their perceptions of the services provided. We built a logistic regression model with potentially influential variables in order to assess their association with overall satisfaction. RESULTS: According to the self-reports of the 722 users interviewed, the following factors were decisive in their overall satisfaction with services: receiving sufficient information during visits (OR = 3.38; 95% CI:1.88-6.06), feeling that their opinions were taken into consideration by clinic staff (OR = 2.58; 95% CI:1.14-5.85), feeling that the motives for their visits were addressed (OR = 2.71; 95% CI:1.29-5.71), being assigned enough time for consultation (OR = 2.35; 95% CI:1.26-4.37), having the opportunity to ask questions and clarify doubts (OR = 2.31; 95% CI:1.21-4.43), experiencing no or few interruptions during their medical consultations (OR = 1.97;95% CI:1.10-3.51), and feeling satisfied with the contraceptive method provided (OR = 1.79; 95% CI:1.03-3.11). CONCLUSIONS: Service providers must be kept well informed on the perspective of users concerning user expectations. Taking into account the cultural context and perceived needs of users while providing service would improve the quality of care and, hence, the overall satisfaction of users.

[Knowledge about pregnancy risk and self-efficacy in adolescent males: parental support and school factors]. / Conocimientos sobre riesgo de embarazo y autoeficacia en hombres adolescentes: apoyo parental y factores escolares.

OBJECTIVE: To identify the association between knowledge about pregnancy risk and self-efficacy in condom use with parental support and school factors in adolescent men. MATERIALS AND METHODS: Cross-sectional study with 448 students in Puebla and Morelos. Two logistic models were adjusted. RESULTS: Knowledge about pregnancy risk is associated with communication about sexuality between parents and sons (OR = 2.45, 95%CI 1.35-4.47), satisfaction with school (OR=2.18, 95%CI 1.15-4.13), if teachers talk about gender equity frequently/very frequently (OR=1.69, 95%CI 1.06-2.67) and with age (OR=1.77, 95%CI 1.26-2.50). Self-efficacy in condom use is statistical related with communication about sexuality between parents and sons (OR=1.80, 95%CI 1.01-3.20), satisfaction with school (OR=2.60, 95%CI 1.42-4.77), belong to middle socioeconomic level (OR=1.82, 95%CI 1.07-3.11) and live in a community with a high degree of marginalization (OR=0.47, 95%CI 0.30-0.73). CONCLUSIONS: To study family and school support, considering the influence of the social environment, allows a greater understanding of skills acquisition for a preventive sexual behavior, in males during early adolescence.

OBJETIVO: Identificar la asociación entre conocimiento sobre riesgo de embarazo y autoeficacia en el uso del condón, con el apoyo parental y factores escolares, en hombres. MATERIAL Y MÉTODOS: Estudio transversal con 448 estudiantes en Puebla y Morelos. Se ajustaron dos modelos logísticos. RESULTADOS: Los conocimientos sobre riesgo de embarazo se asocian con el que los padres hablen sobre sexualidad (RM=2.45, IC95% 1.35-4.47), con el agrado por asistir a la escuela (RM=2.18, IC95% 1.15-4.13), con el que los profesores hablen frecuentemente/muy frecuentemente sobre equidad de género (RM=1.69, IC95% 1.06-2.67) y con la edad (RM=1.77, IC95%1.26-2.50). La autoeficacia en el uso de condón se relaciona con el que los padres hablen sobre sexualidad (RM=1.80, IC95% 1.01-3.20), con el agrado por asistir a la escuela (RM=2.60, IC95% 1.42-4.77), con el nivel socioeconómico medio (RM=1.82, IC95% 1.07-3.11) y con alto grado de marginación (RM=0.47, IC95% 0.30-0.73). CONCLUSIONES: Estudiar el apoyo familiar y escolar, considerando la influencia del entorno social, permite mayor entendimiento de la adquisición de habilidades para una conducta sexual preventiva en hombres durante la adolescencia temprana.

Conocimientos sobre riesgo de embarazo y autoeficacia en hombres adolescentes: apoyo parental y factores escolares / Knowledge about pregnancy risk and self-efficacy in adolescent males: parental support and school factors

Resumen: Objetivo: Identificar la asociación entre conocimiento sobre riesgo de embarazo y autoeficacia en el uso del condón, con el apoyo parental y factores escolares, en hombres. Material y métodos: Estudio transversal con 448 estudiantes en Puebla y Morelos. Se ajustaron dos modelos logísticos. Resultados: Los conocimientos sobre riesgo de embarazo se asocian con el que los padres hablen sobre sexualidad (RM=2.45, IC95% 1.35-4.47), con el agrado por asistir a la escuela (RM=2.18, IC95% 1.15-4.13), con el que los profesores hablen frecuentemente/muy frecuentemente sobre equidad de género (RM=1.69, IC95% 1.06-2.67) y con la edad (RM=1.77, IC95%1.26-2.50). La autoeficacia en el uso de condón se relaciona con el que los padres hablen sobre sexualidad (RM=1.80, IC95% 1.01-3.20), con el agrado por asistir a la escuela (RM=2.60, IC95% 1.42-4.77), con el nivel socioeconómico medio (RM=1.82, IC95% 1.07-3.11) y con alto grado de marginación (RM=0.47, IC95% 0.30-0.73). Conclusiones: Estudiar el apoyo familiar y escolar, considerando la influencia del entorno social, permite mayor entendimiento de la adquisición de habilidades para una conducta sexual preventiva en hombres durante la adolescencia temprana.

Abstract: Objective: To identify the association between knowledge about pregnancy risk and self-efficacy in condom use with parental support and school factors in adolescent men. Materials and methods: Cross-sectional study with 448 students in Puebla and Morelos. Two logistic models were adjusted. Results: Knowledge about pregnancy risk is associated with communication about sexuality between parents and sons (OR = 2.45, 95%CI 1.35-4.47), satisfaction with school (OR=2.18, 95%CI 1.15-4.13), if teachers talk about gender equity frequently/very frequently (OR=1.69, 95%CI 1.06-2.67) and with age (OR=1.77, 95%CI 1.26-2.50). Self-efficacy in condom use is statistical related with communication about sexuality between parents and sons (OR=1.80, 95%CI 1.01-3.20), satisfaction with school (OR=2.60, 95%CI 1.42-4.77), belong to middle socioeconomic level (OR=1.82, 95%CI 1.07-3.11) and live in a community with a high degree of marginalization (OR=0.47, 95%CI 0.30-0.73). Conclusions: To study family and school support, considering the influence of the social environment, allows a greater understanding of skills acquisition for a preventive sexual behavior, in males during early adolescence.

Características de la atención prenatal en adolescentes del Perú, comparación con mujeres adultas / Prenatal care among adolescents in Peru, a comparative analysis with adult women

Objetivos: Describir las prácticas médicas realizadas en la atención prenatal en mujeres en Perú e identificar silas prácticas de control prenatal (CPN) recibidas por mujeres adolescentes y adultas fueron distintas. Material ymétodos: Estudio descriptivo y comparativo. Se utilizaron datos recolectados por la Encuesta Demográfica y de Salud Familiar continua 2004-2008, con 994 adolescentes (15-19 años) y 12556 adultas (20-49 años). Se efectuaron comparaciones entre adolescentes y adultas en relación con las prácticas médicas efectuadas durante la atención prenatal. Resultados: El 50% de las adolescentes inició el CPN en el tercer mes de embarazo en comparacióncon la mitad de las adultas que lo inició en el segundo mes. La mitad de las adolescentes reportaron 7 visitasde CPN en total mientras que el 50% de adultas reportaron 8. Menor proporción de adolescentes reportó haberrecibido algunas de las acciones y prácticas médicas que se efectúan durante la atención prenatal...

Objective: To describe medical practices reported by women that received prenatal care (PNC) in Peru.Particularly, we aim to identify differences in the services provided to adolescents compared to adult women.Methods: Descriptive study. Data came from the Demographic Health Surveys 2004-2008 in Peru, which includedinformation of 994 adolescents (15-19 years old) and 12 556 adult women (20-49 years old). Comparisons weremade between adolescents and adult women regarding the practices received during prenatal care visits. Results:Among adolescents, 50% initiated PNC during the third month of pregnancy whereas half of the adult womenstarted on the second month. Adolescents received 7 prenatal visits comparing to 8 in adult women. Comparing to adult women, adolescents reported in lower proportions that they received some of the medical practices duringprenatal care...

[Inconsistent condom use among Mexican women living with HIV: a challenge for health services]. / El uso inconsistente del condón en mujeres mexicanas que viven con VIH: un reto para los servicios de salud.

OBJECTIVE: To describe condom use among Mexican women living with HIV and analyze factors that facilitate or impede its utilization. MATERIALS AND METHODS: Qualitative analysis of 55 interviews with women of reproductive age living with HIV. RESULTS: Inconsistent condom use and non-use at last sexual intercourse was common, and not clearly related to the male partners' HIV-status. Factors that influenced condom use included perceptions of health benefits, symbolic meaning assigned to the condom within the relationship, and the transformation or persistence of inequitable gender norms. CONCLUSIONS: Gender norms and male partners' attitudes strongly influence condom use among women living with HIV. To increase consistent condom use the health system must implement counseling and service delivery with a gender perspective and innovative actions to involve male partners.

[Teen pregnancy and educational gaps: Analysis of a national survey in Mexico]. / Embarazo adolescente y rezago educativo: análisis de una encuesta nacional en México.

OBJECTIVE: To characterize female adolescents who have been pregnant, and to analyze the association between adolescent pregnancy and educational gaps. MATERIALS AND METHODS: A cross-sectional study was conducted. Data come from the Encuesta Nacional de Salud y Nutrición (Ensanut 2012), a Mexican representative survey. The set of data used is related to sociodemographic and reproductive characteristics from 1 790 women from 12 to 19 years who had begun their sexual life and had a pregnancy record. Three statistical models were adjusted to observe the association between variables. The dependent variable of the first model was the condition of previous pregnancy, the second to be pregnant at the time of data collection, and the third, educational gap. RESULTS: A 74.9% of the adolescents with history of pregnancy has educational gap. To have the condition of previous pregnancy is associated with living with sexual partner (OR=8.4), educational gap (OR=2.4), low socioeconomical level (OR=2.0) and school assistance (OR=0.5). To be pregnant at the time of data collection has related only to living with sexual partner (OR=9.4). The educational gap shows an association with having more than one pregnancy (OR=2.4), live with sexual partner (OR=1.6), low socioeconomical level (OR=1.8), and school assistance as protective factor (OR=0.3). CONCLUSION: It is necessary to implement effective and efficient educational public politics in order to decrease educational gap. At the same time, to guarantee and improve sexual education in the school system to prevent adolescent pregnancy.

Embarazo adolescente y rezago educativo: análisis de una encuesta nacional en México / Teen pregnancy and educational gaps: Analysis of a national survey in Mexico

Objetivo. Caracterizar a las adolescentes que han tenido algún embarazo y analizar la asociación de éste con el rezago educativo, a partir de una encuesta representativa en México. Material y métodos. Estudio transversal con información de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2012, con datos sociodemográficos y reproductivos de 1 790 mujeres de 12 a 19 años de edad con inicio de vida sexual y antecedente de embarazo. Se ajustaron tres modelos estadísticos para observar la asociación entre variables. Resultados. El rezago educativo está presente en 74.9% de las adolescentes con antecedente de embarazo. Tener embarazo previo está asociado con cohabitar con la pareja (RM=8.4), rezago educativo (RM=2.4), nivel socioeconómico bajo (RM=2.0) y asistencia a la escuela (RM=0.5). El rezago educativo muestra una asociación con el antecedente de embarazo alguna vez en la vida (RM=2.4), no así con el primer embarazo al momento de la encuesta. Conclusión. Se requieren políticas y estrategias operativas eficientes para favorecer la permanencia escolar y reducir el rezago educativo en adolescentes con y sin hijos.

Objective. To characterize female adolescents who have been pregnant, and to analyze the association between adolescent pregnancy and educational gaps. Materials and methods. A cross-sectional study was conducted. Data come from the Encuesta Nacional de Salud y Nutrición (Ensanut 2012), a Mexican representative survey. The set of data used is related to sociodemographic and reproductive characteristics from 1 790 women from 12 to 19 years who had begun their sexual life and had a pregnancy record. Three statistical models were adjusted to observe the association between variables. The dependent variable of the first model was the condition of previous pregnancy, the second to be pregnant at the time of data collection, and the third, educational gap. Results. A 74.9% of the adolescents with history of pregnancy has educational gap. To have the condition of previous pregnancy is associated with living with sexual partner (OR=8.4), educational gap (OR=2.4), low socioeconomical level (OR=2.0) and school assistance (OR=0.5). To be pregnant at the time of data collection has related only to living with sexual partner (OR=9.4). The educational gap shows an association with having more than one pregnancy (OR=2.4), live with sexual partner (OR=1.6), low socioeconomical level (OR=1.8), and school assistance as protective factor (OR=0.3). Conclusion. It is necessary to implement effective and efficient educational public politics in order to decrease educational gap. At the same time, to guarantee and improve sexual education in the school system to prevent adolescent pregnancy.