title: [Factors associated with access to health services prior to pregnancy by pregnant adolescents].
abstract: OBJECTIVE
  To assess determinants of access to primary care services prior to pregnancy by pregnant adolescents.
  
  
  METHODS
  Theory-based cross-sectional study conducted to examine access to heath services at five dimensions: geographic, economic, administrative, psychosocial and information. There were included in the study 200 first-time pregnant adolescents (aged 10 to 19 years) who attended a primary care unit in the municipality of Indaiatuba, Southeastern Brazil, in 2003. Data was collected using a semi-structured questionnaire applied in face-to-face interviews conducted just before their first pre-natal care visit. Data analyses were performed through Person's chi-square or Fisher's exact test, and by a multivariate logistic regression model including all five dimensions of access.
  
  
  RESULTS
  More than half (63.7%) of the adolescents utilized some gynecological care service. Information (43.8%) or psychosocial feelings of embarrassment or fear (37.0%) barriers were the most frequent reasons given for not having sought care before. The main barrier to health service access was related to the psychosocial dimension, reported by 77.0% of the adolescents studied.
  
  
  CONCLUSIONS
  Among all barriers to health service access, the most important were those related to the psychosocial dimension. There is a need for new strategies to facilitate access to health services by adolescents, including actions to reduce gender-based barriers taking into consideration sociodemographic characteristics of this population and the relationship they have with their partners.
authors.affiliation: Secretaria Municipal de Saúde de Indaiatuba, Indaiatuba, SP, Brasil. ingridespejo@bol.com.br
authors.forename: Ingrid Espejo
authors.initials: IE
authors.lastname: Carvacho
authors.forename: Maeve Brito de
authors.initials: MB
authors.lastname: Mello
authors.forename: Sirlei Siani
authors.initials: SS
authors.lastname: Morais
authors.forename: João Luiz Pinto E
authors.initials: JL
authors.lastname: Silva
mesh_terms: D022126:Access to Information; D000293:Adolescent; D001071:Appointments and Schedules; D001938:Brazil; D002648:Child; D004812:Epidemiologic Methods; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000523:psychology / Q000706:statistics & numerical data*; D011320:Primary Health Care; D034121:Reproductive Health Services; D018456:Reproductive Medicine; D012747:Sexual Partners; D012959:Socioeconomic Factors; D055815:Young Adult