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.

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.

Cerclage Location and Gestational Age at Delivery.

Objective Multiple authors have suggested cerclage position is a determinant of "success." We assessed the interaction between cervical length (CL), cerclage height (cerH), proximal residual length (PRL), gestational age at delivery, and rate of delivery ≤ 34 weeks, in this study. Study Design Present study is a retrospective cohort study of all cerclages placed at Maimonides Medical Center from 2006 to 2016. Outcomes: gestational age at delivery and delivery before 34 weeks; predictors: PRL, cerH, CL; and indications for cerclage: history (Hx), physical exam (PE), and ultrasound (US) indicated cerclage. A general linear model was used to predict power-transformed age at delivery from cerH, CL, and indication for cerclage. Subanalyses by indication were conducted. Logistic regression was used for delivery ≤ 34 weeks. Results The cerH by indication did not reach statistical significance ( p = 0.090). When stratified by indications, the effect of cerH on age at delivery was apparent for Hx (adjusted R 2 = 0.18, p < 0.001) and PE (adjusted R 2 = 0.43, p = 0.004) cerclages but not for US cerclages (adjusted R 2 = 0.08, p = 0.206). Logistic regression predicting delivery ≤ 34 weeks ( n = 29) produced similar results. Conclusions For Hx and PE indicated cerclages, the location of the stitch may influence the timing of delivery. Specifically, the higher the cerclage, the more advanced the gestational age at delivery.

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.

[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.

PRONTO training for obstetric and neonatal emergencies in Mexico.

OBJECTIVE: To evaluate the acceptability, feasibility, rating, and potential impact of PRONTO, a low-tech and high-fidelity simulation-based training for obstetric and neonatal emergencies and teamwork using the PartoPants low-cost birth simulator. METHODS: A pilot project was conducted from September 21, 2009, to April 9, 2010, to train interprofessional teams from 5 community hospitals in the states of Mexico and Chiapas. Module I (teamwork, neonatal resuscitation, and obstetric hemorrhage) was followed 3 months later by module II (dystocia and pre-eclampsia/eclampsia) and an evaluation. Four elements were assessed: acceptability; feasibility and rating; institutional goal achievement; teamwork improvement; and knowledge and self-efficacy. RESULTS: The program was rated highly both by trainees and by non-trainees who completed a survey and interview. Hospital goals identified by participants in the module I strategic-planning sessions were achieved for 65% of goals in 3 months. Teamwork, knowledge, and self-efficacy scores improved. CONCLUSION: PRONTO brings simulation training to low-resource settings and can empower interprofessional teams to respond more effectively within their institutional limitations to emergencies involving women and newborns. Further study is warranted to evaluate the potential impact of the program on obstetric and neonatal outcome.

[Interventions involving parents in order to impact adolescent sexual behavior]. / Intervenciones con padres de familia para modificar el comportamiento sexual en adolescentes.

OBJECTIVE: To examine the effects of educational interventions that incorporate parent participation to modify adolescent sexual behavior. MATERIAL AND METHODS: We conducted a systematic search of 5 electronic databases for articles published between 2002 and 2009 that evaluated educational interventions involving parents. RESULTS: Nineteen articles evaluated 15 interventions that met all the criteria for inclusion. They found a significant increase in adolescents' intentions to postpone sexual intercourse and use contraceptives, a reduction in self-reported sexual relations and an increase in condom use. Positive results were also found for individual protective factors such as knowledge and attitude, and family factors such as parent-child communication, perception of rules, monitoring/supervision by parents and family support. CONCLUSION: Educational interventions that include parents support healthy sexual behavior among adolescents. Parental participation can be included in any intervention aimed at adolescents.

Intervenciones con padres de familia para modificar el comportamiento sexual en adolescentes / Interventions involving parents in order to impact adolescent sexual behavior

OBJETIVO: Revisar los efectos de intervenciones educativas que incorporan a padres de familia, para modificar el comportamiento sexual de sus hijos adolescentes. MATERIAL Y MÉTODOS: Búsqueda sistemática en cinco bases de datos electrónicas de estudios de evaluación de intervenciones educativas con padres (2002-2009). RESULTADOS: Diecinueve publicaciones evalúan a 15 programas que cumplen con los criterios de selección. Éstas encuentran un aumento en las intenciones de retrasar las relaciones sexuales y de usar anticonceptivos, reducción en el auto-reporte de relaciones sexuales e incremento en el uso de condón. También se encuentran resultados positivos en factores individuales protectores como conocimientos y actitudes; y en factores familiares como comunicación padres-hijos, percepción de reglas, monitoreo/supervisión de los padres y apoyo familiar. CONCLUSIONES: Las intervenciones educativas que incluyen a padres de familia favorecen comportamientos sexuales saludables en los adolescentes. La participación de padres es un elemento que puede ser incluido en cualquier intervención para adolescentes.

OBJECTIVE: To examine the effects of educational interventions that incorporate parent participation to modify adolescent sexual behavior. MATERIAL AND METHODS: We conducted a systematic search of 5 electronic databases for articles published between 2002 and 2009 that evaluated educational interventions involving parents. RESULTS: Nineteen articles evaluated 15 interventions that met all the criteria for inclusion. They found a significant increase in adolescents' intentions to postpone sexual intercourse and use contraceptives, a reduction in self-reported sexual relations and an increase in condom use. Positive results were also found for individual protective factors such as knowledge and attitude, and family factors such as parent-child communication, perception of rules, monitoring/supervision by parents and family support. CONCLUSIÓN: Educational interventions that include parents support healthy sexual behavior among adolescents. Parental participation can be included in any intervention aimed at adolescents.

Gender, culture and reproductive decision-making among recent Mexican migrants in California.

This study of the experiences of recent Mexican immigrants living in California explores the changing perceptions of sexual and societal norms, including gender roles and resulting reproductive decision-making, that appear to accompany the migration process. These norms are compared to those held by migrants' families of origin in Mexico. We analysed 44 semi-structured interviews conducted with a client-based population in order to identify reproductive perceptions and practices that appear to be influenced by recent migration. Using a grounded theory approach, 26 women and 18 men's narratives were analysed to understand the complexity of changing expectations and resulting reproductive health practises. The social marginalisation and isolation of immigrants' experiences, the challenges of new socio-economic factors and access to health services appear to reshape views on reproductive decisions. While traditional gender roles and large families remain a spoken ideal, in practice these reproductive patterns are changing. Our analysis suggests that the migration process does alter relationships, reproductive decisions and contraceptive use among recent Mexican immigrants. The public health goal should be to provide an array of accessible and affordable services, tailored to the needs of this increasingly larger population of recent Mexican migrants in California and throughout the USA.

Uso de servicios de planificación familiar de la Secretaría de Salud, poder de decisión de la mujer y apoyo de la pareja / Use of family planning services and its relationship with women's decision-makingand support from their partner

OBJETIVO: Identificar la influencia de las características reproductivas y el empoderamiento femenino en el uso de servicios de planificación familiar (PF). MATERIAL Y MÉTODOS: Diseño de casos y no casos pareado por controles vecindarios (147 usuarias y 146 no usuarias de servicios de PF de la Secretaría de Salud durante 2003), en dos municipios del estado de Guanajuato, México. Análisis logístico multivariado para identificar diferencias entre usuarias y no usuarias. RESULTADOS: El uso de servicios de PF se asoció positiva y significativamente con poder de decisión de la mujer (alto: RM=3.2; IC95 por ciento 1.4-7.4); comunicación con la pareja para el uso de métodos de PF (RM =3.5; IC95 por ciento 1.4-9.3), y número de embarazos en su vida (> 6 hijos: RM =4.4; IC95 por ciento 1.4-13.8). CONCLUSIONES: El desarrollo de estrategias que involucren a los hombres y que, por otra parte, fomenten y fortalezcan el empoderamiento femenino, puede contribuir a una mayor utilización de servicios de PF.

OBJECTIVE: To identify the influence of reproductive characteristics and women empowerment with the use of family planning services. MATERIAL AND METHODS: Cases and non-cases design with neighborhood controls (147 users and 146 non-users of family planning services during 2003), in Guanajuato State, Mexico. Various indexes were constructed to evaluate women's empowerment and its relationship with family planning use. RESULTS: The use of family planning services was positively and significantly associated with the woman's power to make decisions (High: OR 3.2, CI95 percent 1.4-7.4), a high level of communication with her partner on contraceptive use (OR 3.5, CI95 percent 1.4-9.3); and a greater number of pregnancies (> 6 children: OR 4.4, CI95 percent 1.4-13.8). CONCLUSION: Factors such as a high level of female decision-making and more partner support for contraceptive use are related to the use of family planning services. Therefore, developing strategies that involve men and support female empowerment could contribute to increasing the use of family planning services.

[Use of family planning services and its relationship with women's decision-making and support from their partner]. / Uso de servicios de planificación familiar de la Secretaría de Salud, poder de decisión de la mujer y apoyo de la pareja.

OBJECTIVE: To identify the influence of reproductive characteristics and women empowerment with the use of family planning services. MATERIAL AND METHODS: Cases and non-cases design with neighborhood controls (147 users and 146 non-users of family planning services during 2003), in Guanajuato State, Mexico. Various indexes were constructed to evaluate women's empowerment and its relationship with family planning use. RESULTS: The use of family planning services was positively and significantly associated with the woman's power to make decisions (High: OR 3.2, CI95% 1.4-7.4), a high level of communication with her partner on contraceptive use (OR 3.5, CI95% 1.4-9.3); and a greater number of pregnancies (> 6 children: OR 4.4, CI95% 1.4-13.8). CONCLUSION: Factors such as a high level of female decision-making and more partner support for contraceptive use are related to the use of family planning services. Therefore, developing strategies that involve men and support female empowerment could contribute to increasing the use of family planning services.