Barriers to sexual and reproductive care among cisgender, heterosexual and LGBTQIA + adolescents in the border region: provider and adolescent perspectives

Abstract

Introduction

The United States (U.S.) has higher rates of sexually transmitted infections (STIs) and adolescent pregnancy than most other industrialized countries. Furthermore, health disparities persist among racial and ethnic minority adolescents (e.g., African American and Latinx) and in counties located along the U.S.–Mexico border region—they demonstrate the highest rates of STIs and unintended pregnancy among adolescents.

Methods

Qualitative data were collected as part of formative research for the development of a mobile app that provides gender-inclusive sexual education to adolescents living in the U.S.—Mexico border region. From August 2019 to March 2020, the study team conducted 11 in-depth interviews with healthcare providers and three focus groups with cisgender, heterosexual, and SGM adolescents ages 15–18 (n = 20).

Results

Providers and adolescents reported similar barriers to accessing SRH in this region such as transportation, lack of insurance and cost of services or accessing services without their parent’s knowledge. However, providers shared that some adolescents in this region face extreme poverty, family separation (i.e., parent has been deported), have a mixed family legal status or are binational and have to travel every day from Mexico to the U.S. for school. These challenges further limit their ability to access SRH.

Conclusions

Adolescents in the U.S.-Mexico border region face unique economic and social challenges that further limit their access to SRH care, making them uniquely vulnerable to STIs and unintended pregnancy. The prototype of the app was developed based on the needs expressed by providers and adolescents, including providing comprehensive Sex Ed and mapping of free comprehensive and confidencial SRH services available in the region and is being pilot tested. Our findings provide further evidence for the need for interventions and service delivery, programs tailored for residents in the border region.

Plain language summary

The United States (U.S.) has higher rates of sexually transmitted infections (STIs) and adolescent pregnancy than most other industrialized countries. Furthermore, health disparities persist among racial and ethnic minority adolescents (e.g., African American and Latinx) and in counties located along the U.S.–Mexico border region—they demonstrate the highest rates of STIs and unintended pregnancy among adolescents. A study was conducted as part of formative research for the development of a mobile app that provides gender-inclusive sexual education to adolescents living in the U.S.—Mexico border region. From August 2019 to March 2020, the study team conducted 11 in-depth interviews with healthcare providers and three focus groups with cisgender, heterosexual, and SGM adolescents ages 15–18 (n = 20). Providers and adolescents reported similar difficulties accessing care such as transportation, lack of insurance and cost of services or accessing services without their parent’s knowledge. However, providers shared that some adolescents in this region face extreme poverty, family separation (i.e., parent has been deported), have a mixed family legal status or are binational and have to travel every day from Mexico to the U.S. for school. It is evident that adolescents in the U.S.-Mexico border region face unique challenges that further limit their access to care, making them uniquely vulnerable to STIs and unintended pregnancy. The prototype of the app was developed based on the needs expressed by participants and is being pilot tested. Our findings provide further evidence for the need for service delivery and programs tailored for residents in the border region.

Resumen

Introducción

Estados Unidos (EE. UU.) tiene tasas más altas de enfermedades de transmisión sexual (ETS) y embarazo en adolescentes comparado a otros países industrializados. Además, las disparidades de salud persisten entre los adolescentes que son minorías (por ejemplo, Afroamericanos y Latinos) y en los condados ubicados a lo largo de la región fronteriza de EE. UU. y México, donde se muestran las tasas más altas de ETS y embarazos no deseados en adolescentes.

Métodos

Se recolectaron datos cualitativos como parte de una investigación formativa para el desarrollo de una aplicación móvil que brinda educación sexual a adolescentes que viven en la región fronteriza. De agosto del 2019 a marzo del 2020, se llevaron acabo 11 entrevistas a profundidad con proveedores de salud y tres grupos focales con adolescentes cisgénero, heterosexuales y LGBTQIA + de 15 a 18 años (n = 20).

Resultados

Los proveedores y los adolescentes informaron barreras similares para acceder a los servicios de salud sexual y reproductiva (SSR) como el transporte, la falta de seguro médico, el costo de los servicios y acceder a los servicios sin el conocimiento de sus padres. Además, los proveedores compartieron que algunos adolescentes enfrentan pobreza extrema, separación familiar (por ejemplo, el padre ha sido deportado), tienen un estatus legal familiar mixto o son binacionales y tienen que viajar todos los días de México a los EE. UU. para ir a la escuela.

Conclusiones

Los adolescentes en la región fronteriza de EE. UU. y México enfrentan desafíos económicos y sociales únicos que limitan aún más su acceso a SSR, lo que los hace especialmente vulnerables a las ETS y a los embarazos no deseados. El prototipo de la aplicación fue desarrollado en base a las necesidades expresadas por los proveedores y los adolescentes, como educación sexual integral y mapeo de los servicios de SSR gratuitos y confidenciales disponibles en la región, y se esta llevando acabo la prueba piloto. Nuestros hallazgos evidencian la necesidad de intervenciones y programas de SSR que se adapten a las necesidades únicas que enfrentan los adolescentes en esta región.