title: Uncovering and responding to needs for sexual and reproductive health care among poor urban female adolescents in Nicaragua.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Netherlands Institute for Health Service Research, Utrecht, The Netherlands. Liesbethmeuwissen@yahoo.com
authors.forename: Liesbeth E
authors.initials: LE
authors.lastname: Meuwissen
authors.forename: Anna C
authors.initials: AC
authors.lastname: Gorter
authors.forename: Zoyla
authors.initials: Z
authors.lastname: Segura
authors.forename: Arnold D M
authors.initials: AD
authors.lastname: Kester
authors.forename: J A
authors.initials: JA
authors.lastname: Knottnerus
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D016497:Adolescent Health Services / Q000458:organization & administration*; D000328:Adult; D002648:Child; D003268:Contraception Behavior / Q000706:statistics & numerical data; D003906:Developing Countries; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D009527:Nicaragua; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration; D034121:Reproductive Health Services / Q000458:organization & administration*; D019037:Urban Health Services / Q000458:organization & administration