title: Quality of reproductive healthcare for adolescents: A nationally representative survey of providers in Mexico.
abstract: OBJECTIVE
  Adolescents need sexual and reproductive health services but little is known about quality-of-care in lower- and middle-income countries where most of the world's adolescents reside. Quality-of-care has important implications as lower quality may be linked to higher unplanned pregnancy and sexually transmitted infection rates. This study sought to generate evidence about quality-of-care in public sexual and reproductive health services for adolescents.
  
  
  METHODS
  This cross-sectional study had a complex, probabilistic, stratified sampling design, representative at the national, regional and rural/urban level in Mexico, collecting provider questionnaires at 505 primary care units in 2012. A sexual and reproductive quality-of-healthcare index was defined and multinomial logistic regression was utilized in 2015.
  
  
  RESULTS
  At the national level 13.9% (95%CI: 6.9-26.0) of healthcare units provide low quality, 68.6% (95%CI: 58.4-77.3) medium quality and 17.5% (95%CI: 11.9-25.0) high quality reproductive healthcare services to adolescents. Urban or metropolitan primary care units were at least 10 times more likely to provide high quality care than those in rural areas. Units with a space specifically for counseling adolescents were at least 8 times more likely to provide high quality care. Ministry of Health clinics provided the lowest quality of service, while those from Social Security for the Underserved provided the best.
  
  
  CONCLUSIONS
  The study indicates higher quality sexual and reproductive healthcare services are needed. In Mexico and other middle- to low-income countries where quality-of-care has been shown to be a problem, incorporating adolescent-friendly, gender-equity and rights-based perspectives could contribute to improvement. Setting and disseminating standards for care in guidelines and providing tools such as algorithms could help healthcare personnel provide higher quality care.
authors.affiliation: Public Health Methods Department, Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico.
authors.forename: Aremis
authors.initials: A
authors.lastname: Villalobos
authors.affiliation: Public Health Methods Department, Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico.
authors.forename: Betania
authors.identifier: http://orcid.org/0000-0002-9097-2553
authors.initials: B
authors.lastname: Allen-Leigh
authors.affiliation: Colectivo Sol, A.C., Mexico City, Mexico.
authors.forename: Javier
authors.initials: J
authors.lastname: Salazar-Alberto
authors.affiliation: Public Health Methods Department, Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico.
authors.forename: Filipa
authors.initials: F
authors.lastname: De Castro
authors.affiliation: Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico.
authors.forename: Tonatiuh
authors.initials: T
authors.lastname: Barrientos-Gutiérrez
authors.affiliation: Gender and Health Department, Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
authors.forename: Ahideé
authors.initials: A
authors.lastname: Leyva-López
authors.affiliation: Public Health Methods Department, Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico.
authors.forename: Rosalba
authors.initials: R
authors.lastname: Rojas-Martínez
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003376:Counseling; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006282:Health Personnel; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D011787:Quality of Health Care; D034121:Reproductive Health Services / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data*; D055815:Young Adult