[Factors associated with access to health services prior to pregnancy by pregnant adolescents].
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.
Carvacho
Ingrid Espejo
IE
Secretaria Municipal de Saúde de Indaiatuba, Indaiatuba, SP, Brasil. ingridespejo@bol.com.br
Mello
Maeve Brito de
MB
Morais
Sirlei Siani
SS
Silva
João Luiz Pinto E
JL
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