Vouching for access: adolescent sexual health in Nicaragua

There is an urgent need for effective, low-cost programmes that help adolescents to protect themselves from unplanned pregnancies and sexually transmitted infections (STI). Research in Managua, the capital of Nicaragua, shows that a free voucher scheme could help to meet this need.

Nicaragua has the highest fertility rate in Latin America. Eight percent of 15 year old girls are mothers or pregnant. By age 19, this increases to 45 percent. Early sexual debut and high fertility rates are linked to low socioeconomic status and educational level. Adolescents have high rates of unwanted pregnancy, illegal abortions and maternal mortality and a greater risk of STI, including HIV.

Obstacles to sexual and reproductive health care (SRHC) for teenagers include:

• lack of information about sexual and reproductive health
• limited access to SRHC services
• low quality of care.

To help adolescents overcome these obstacles, researchers from the Instituto Centro Americano de la Salud, Nicaragua and the London School of Hygiene and Tropical Medicine distributed 28,711 vouchers in disadvantaged neighbourhoods, at markets and in schools. The vouchers offered free access to SRHC in 20 health centres in Managua. Records showed that 3,067 girls used vouchers to access one or more services for:

• family planning (34 percent)
• treatment of reproductive tract infections (31 percent)
• antenatal care (28 percent)
• counselling (28 percent)
• pregnancy testing (18 percent)
• other reasons (15 percent)

A community-based survey of 3,009 females aged 12 to 20 years (904 receiving vouchers and 2,015 not) showed that

• More than half of 1,025 sexually-active girls who received a voucher used it, compared with only 14 percent of girls who are not sexually active.
• Young women who receive vouchers make greater use of SRHC than those who do not (34 versus 19 percent).
• Girls who benefit most from vouchers are those who are at school, younger, or less well-educated.
• Those who received vouchers also had better knowledge of contraceptives, STIs and their prevention through condom use.
• Condom use during last sexual contact is more common among those with vouchers, especially those who are surveyed in neighbourhoods.
• Use of contraceptives increased among those receiving vouchers who were surveyed outside schools.

This study shows that many girls are motivated to protect themselves against the risks of sexual intercourse once they have access to reliable information and confidential health services. Adolescents are a diverse group and the researchers highlight the need to classify them in order to meet their specific needs. They conclude that these needs for SRHC can be met through a relatively simple programme using existing health facilities, even within a conservative political climate.

Source(s):
‘Impact of accessible sexual and reproductive health care on poor and underserved adolescents in Managua, Nicaragua: a quasi-experimental intervention study’, Journal of Adolescent Health 38: 56.e1-56.e9, by Liesbeth Meuwissen, Anna Gorter and André Knottnerus, 2006 Full document.
'Uncovering and responding to needs for sexual and reproductive health care among poor urban female adolescents in Nicaragua' Tropical Medicine and International Health, by Liesbeth Meuwissen, Anna Gorter, Zoyla Segura, A.D.M. Kester and André Knottnerus, 2006 [in press]
HINARI subscribers can access the full-text article here. Full document.

id21 Research Highlight: 12 September 2006

Further Information:
Liesbeth Meuwissen
Ruysdaelplein 10
3723 CD Bilthoven
The Netherlands

Contact the contributor: liesbethmeuwissen@yahoo.com

Instituto Centroamericano de la Salud (ICAS), Nicaragua

London School of Hygiene and Tropical Medicine, UK

Other related links:
'Counting the cost of a competitive voucher scheme for STI treatment in Nicaragua'

'Paid to be healthy: health prevention in Honduras'

'Can health vouchers help vulnerable groups?'

'Competitive voucher schemes: can they improve healthcare for the poor?'

'Vouching for health: HIV prevention for sex workers in Nicaragua'

'Having their say – young people and sexual health in Nicaragua'

'Meeting their needs? Discussing young people’s sexual health'