Adolescent Access to Information on Contraceptives: A Mystery Client Study in Mexico

We aimed to evaluate adolescent access to contraceptive information and quality of care in a sample of primary care clinics and pharmacies in Mexico and their association with health facility and adolescent characteristics.

We selected a random sample of pharmacies (n = 434) and public-sector, primary care clinics (n = 327) in Mexico City to be visited by young women posing as "mystery clients" looking for contraception or emergency contraception. Access to contraception information was measured as the percent of times that women received the information they requested. To assess quality of care, we built an "adolescent-friendly services" (AFS) score based on the World Health Organization framework. Regression models were fitted to evaluate the associations between outcomes and health facility and client characteristics.

Twenty percent of women did not receive the information they requested. Clients seeking emergency contraception information had higher odds of obtaining it than clients seeking information on contraception (odds ratio 3.08 95% confidence interval 2.03, 4.67). AFS scores were low, although higher in clinics than in pharmacies (5/9 in clinics vs. 3/9 in pharmacies). Younger age and indigenous appearance were associated with lower quality as measured by the AFS score.

Access to information about contraception in pharmacies and clinics is high, but efforts must be made to provide 100% coverage to adolescents. The quality of contraception services in pharmacies and clinics is poor and nonequitable, favoring older and nonindigenous adolescents. Clinics and pharmacies must strive to comply with international AFS guidelines.