Contraceptive access experiences and perspectives of Mexican-origin youth: a binational qualitative study

Figures & data

Table 1. Dimensions of Access* for contraception and sexual and reproductive health (SRH) services.

Dimension	Definition	Examples
Accessibility	“Accessible” services and resources are near to the intended user	• Contraception is accessible at nearby locations
		• SRH services are accessible within a short distance
Availability	“Available” services and resources are sufficient to meet community demand	• Trained providers are available to competently provide the full range of contraception and other SRH services
		• Health care settings maintain a stock of all contraception and related resources
Acceptability	“Acceptable” services and resources align with the sociocultural norms and practices of the user	• Users perceive contraception options and use to be acceptable for themselves and to their community
		• Users find the available providers to be acceptable to deliver SRH services
Affordability	“Affordable” services and resources suggest reasonable financial cost to the user	• Contraception and SRH services are low- or no-cost (and/or the cost is covered by low- or no-cost health insurance)
Adequacy	“Adequate” services and resources are organised in a way the target population can understand and user-friendly	• Information about available contraception accommodates users’ needs and desires
		• SRH clinics maintain relevant hours and user-friendly appointment systems
Awareness	“Awareness” of services and resources is achieved through effective communication and dissemination of relevant information	• Communication about contraception and SRH services builds health literacy among intended users
		• Information about contraception and other SRH services is relevant to its context
Agency	“Agency” entails the ability and personal autonomy to act upon a desire to seek and acquire, or to avoid, services	• Users are able to acquire the SRH services they desire when and how they wish
		• SRH services are free of coercion

*Adapted and expanded from Saurman²⁵.

Table 2. Participant demographics by location

	Guanajuato, Mexico		Fresno, California
	n (49)	%	n (25)	%
Age (mean)	17.2		17.6
Age
≤16	15	30.6	4	16.0
17 to 18	23	46.9	17	68.0
19 to 20	11	22.5	4	16.0
Currently in school
No	44	89.8	5	20.0
Yes	5	10.2	20	80.0
Highest level of education
Elementary	10	20.4	0	0.0
Middle	28	57.1	2	8.0
Some high school	7	14.3	15	60.0
Finished high school	2	4.1	6	24.0
Some college	0	0.0	2	8.0
Missing	2	4.1	0	0.0
Relationship status
Single	3	6.1	9	36.0
In a relationship but not living with partner	8	16.3	6	24.0
Married or living with male partner	37	75.5	10	40.0
Other	1	2.1	0	0.0
Childbearing status
Pregnant	22	44.9	3	12.0
Parenting	27	55.1	22	88.0

Table 3. Knowledge and use of contraceptive resources by location

	Guanajuato, Mexico		Fresno, California
	n (49)	%	n (25)	%
Knowledge of a clinic/provider offering youth-friendly SRH services
No	12	24.5	1	4.0
Yes	31	63.3	22	88.0
Not sure	5	10.2	1	4.0
Missing	1	2.0	1	4.0
Methods of contraception ever used*
None	14	28.6	2	8.0
Condoms	25	51.0	14	56.0
LARCs (IUD, Implant)	6	12.2	12	48.0
Hormonal methods (Pill, Injectables, Vaginal Ring, Patch)	7	14.3	13	52.0
Non-hormonal methods (Withdrawal, Rhythm method)	2	4.1	8	32.0
Emergency contraceptive	3	6.1	0	0.0
Missing	2	4.1	0	0.0
Methods of contraception currently used**
None	6	12.2	5	20.0
Condoms	4	8.2	5	20.0
LARCs (IUD, Implant)	9	18.2	11	44.0
Hormonal methods (Pill, Injectables, Vaginal Ring, Patch)	3	6.1	1	4.0
Non-hormonal methods (Withdrawal, Rhythm method)	0	0.0	2	8.0
Emergency contraceptive	0	0.0	0	0.0
Missing	5	10.2	0	0.0

*Participants could select more than one answer.

**Includes only post-partum participants (n = 27 from Guanajuato, n = 22 from Fresno); Participants could select more than one answer and Guanajuato participants reported no method or 1 single method while 2 Fresno participants reported condom use along with a second method.

Table 4. Shared and location-specific findings by Dimensions of Access* related to contraception and sexual and reproductive health (SRH) services among youth and young adults

Guanajuato findings	Shared findings	Fresno findings
Availability Delays in receiving anything but condoms Barriers to young people obtaining LARCs before or after first birth Agency Denial of preferred method Contraceptive coercion by providers	Acceptability General influence of family, friends, or providers Stigma surrounding parental and/or peer perceptions of youth contraceptive use Fear of side effects (i.e. pain) related to contraceptive use Participant desire for pregnancy or prevention Affordability Inadequate access to free, confidential contraception increasing pursuit of higher cost options via pharmacies Awareness Presence or absence of SRH-related community and media outreach Knowledge or lack of knowledge about contraceptive options Inconsistent use of short-acting methods (i.e. missing a pill)	Accessibility Unclear presence/ location of school-based SRH resources Adequacy Inadequate contraceptive education Unclear schedule of health resource trailer at school

*Adapted and expanded from Saurman²⁵.

Saurman E. Improving access: modifying Penchansky and Thomas’s theory of access. J Health Serv Res Policy. 2016;21(1):36–39. doi:10.1177/1355819615600001.

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